2. Why Peptic Ulcers Are Developed
According to the Merck Manual, “Peptic ulcer occurs only if the stomach secretes acid.” It goes on to say, “Most people secrete acid; some develop ulcers and others do not.” This is misleading. Everyone secretes acid, in fact, it is imperative for protein digestion. Hydrochloric acid is secreted for this reason. Then why doesn’t everyone develop peptic ulcers? There are many factors to take into consideration, but dietary habits play an important part in the etiology of this disease.
Many people abuse their stomachs with a diet that is primarily, if not entirely, acid forming. For example, a diet that consists principally of meat, bread and pastries would be definitely acid forming. The parietal cells of the gastric glands secrete the hydrochloric acid from chlorides such as sodium chloride, found in the blood. The chloride ion combines with the hydrogen ion and is then secreted upon the free surface of the stomach as hydrochloric acid. In normal gastric juice it is found in the proportion of about 0.5 percent, having a pH value of about 1. It serves to activate pepsinogen and convert it to pepsin, a digestive, proteolytic enzyme, and to provide an acid medium which is necessary for the pepsin to carry on its digestive functions; to swell and denature the food protein giving easier access to pepsin; to help in the hydrolysis of sugar and starch.
Most Americans use an excessive amount of salt (sodium chloride) on their food (any amount is excessive). This could be one reason for an abnormal secretion of hydrochloric acid in people with peptic ulcers. Sodium chloride is essential for normal digestion but only that form that is obtained from natural sources such as found in tomatoes, celery, lettuce, cucumbers, avocados, etc. When we obtain this mineral from natural food sources, imbalances and excesses do not occur.
Meat in itself contains many acids that are difficult for our body to handle, for example uric acid. It also requires a large amount of hydrochloric acid for its difficult digestion. Continued abuse will eventually weaken an organ or gland and may result in abnormalities. Thus, hydrochloric acid could continue to be excreted in excess even when not needed in such large amounts. However, continued abuse weakens; rest restores. So fasting is the logical step to restore function to a deranged organ.
Other factors can result in peptic ulcers as well. Alcohol, cigarette smoking and coffee drinking are causative factors. Stress has been implicated as a common factor. Certain drugs, such as aspirin and other nonsteroidal anti-inflammatory drugs, reserpine, and possibly corticosteroids may initiate the formation of an ulcer. These ulcers tend to heal when the drug is discontinued and are unlikely to recur unless the drug is taken again.
2.1 Development of Ulcers
A single ulcer is most common, but two and occasionally more (duodenal, gastric, or both) do occur. Ulcers penetrate into the submucosa or muscular layer. A thin layer of gray or white exudate usually covers the crater base which is composed of fibroid, granulation, and fibrous tissue layers.
Duodenal ulcers are almost always benign, but a gastric ulcer may be malignant. Keep in mind, however, that this situation does not occur overnight. The same pattern of events must first occur as in all other disease processes. Beginning with enervation, the stages of diseases run through toxicosis, irritation, inflammation until we arrive at ulceration. If the causes are not removed by this time, the process will run through induration and end in cancer.
The time to halt the development of ulcers is at the first sign of enervation. A fast and a thorough examination of your lifestyle is in order at this point. If the process has run further along the stages leading to ulceration, health can still be restored through a physiological rest and adherent to a healthful lifestyle.
2.2 Signs and Symptoms
Symptoms vary with the location of the ulcer and the person’s age. Some people may not notice any symptoms; others notice them when some severe symptom such as hemorrhage or obstruction develops. The “typical” pain is described as burning, gnawing, or aching, but the distress may also be described as soreness, an empty feeling or hunger. The pain may be steady, mild or moderately severe. Dr. Shelton tells us to stop eating whenever there is any discomfort at all and this is good advice. By following this rule, you may interrupt the development of the ulcer and halt the reason for its occurrence. But you must also stop those bad habits that caused the irritation in the first place. In other words, it does no good to fast and then go back to your old eating habits. You must remove the cause.
In people with duodenal ulcers, the pain, often tends to follow a consistent pattern; it is absent when the person awakens, but appears in mid-morning. It disappears after eating, but recurs two or three hours after a meal. Pain often awakens the sufferer at 1 or 2 a.m. Frequently, the pain occurs once or more each day for one to several weeks, and may then disappear. However, recurrence is usual, if the cause of the distress is not removed.
With medical treatment, symptoms are palliated with drugs. Under this type of treatment, healing may occur, but takes six weeks or longer. Most often, however, true healing does not occur at all and more than 50% of the people have recurrent pain within two years of completing treatments.
When tissue is damaged, as in an ulcer, an attempt is made by the cells of the tissues to restore the structure and function to normal. To do this, it is necessary first to remove the damaged material and secondly to replace it by proliferation of pre-existing cells.
Cells have a limited life and are replaced by a process of cell division of pre-existing similar cells. Cell division and proliferation is mainly done in the bone marrow of the ribs, sternum, pelvis and spine. The dividing cells may be a mature specialized cells which produces two similar daughter cells. Often, cells which divide are “stem” cells, one of which stays in the stem cell pool in the bone marrow to divide again. The other daughter cell either matures itself, or divides again to form two “grand-daughters” which mature and differentiate into specialized cells.
Healing of an ulcer is the same as wound healing. When the skin is broken, the tissue is first sealed by plasma which leaks from the severed ends of small capillary blood vessels. It clots forming a glue-like substance which binds the sites of the wound together. This substance is largely protein in nature.
Small buds of cytoplasm from the capillary lining cells move into the clot where they fuse in the middle. The neutrophils and macrophages now move to the site and remove debris and phagocytosis. Fibroblasts begin to synthesize collagen fibers which are laid down in amounts greater than normally found in the skin. This forms the scar tissue which is normally seen after healing of any cut. The epithelial cells move and divide and eventually restore the skin to normal proportions.
The body has this system of healing that restores health and integrity to any severed part. Nothing we can do (in the form of drugs and treatments) will do any healing. The best thing to do is to “intelligently do nothing.”
Under a Hygienic regimen, healing occurs perfectly and completely with no recurrences as long as the person strays with the healthful lifestyle outline for him. That is, proper rest and sleep, proper food and water, pure air and sunshine, exercise, emotional poise, etc.
Orthodox treatment for gastric and duodenal ulcer is designed to neutralize or decrease gastric acidity, even when gastric acidity is normal in patients with gastric ulcer. Sedatives or tranquilizers are given to those people who show anxiety or depression.
Keep in mind that health can never be restored with this system of palliation. It can only result in worse diseases and complications. Let us now examine some specific treatments given to these patients and see where their weaknesses lie.
Most physicians do not educate their clients regarding a proper diet. Although they often suggest eliminating spicy and fatty foods, coffee, tea, cocoa, and cola drinks, their dietary recommendations are not conducive to health. The “bland diet” is still recommended by some, and this diet could not keep a well person healthy—much less contribute to the restoration of health to a sick individual.
After the fast, a diet of fresh raw fruits, vegetables, nuts and seeds should be introduced. At the very beginning, it may be necessary to start with blended fruits or fruit juices and the most tender succulent vegetables. Nuts may be taken in the form of nut milks. Very soon, however, whole fruits and vegetables will be handled very well. If a person stays on this diet and does not overeat, peptic ulcers will not recur.
Antacids give symptomatic relief but do not restore health as causes have not been removed or corrected. There are two types of antacids. The first is absorbable antacids. Sodium bicarbonate and calcium carbonate, the most potent antacids, are occasionally taken for short-term symptomatic relief, but because they are absorbable, continuous use may result in alkalosis. Since symptoms of this toxicity are not distinctive (nausea, headache, weakness), the disorder may progress unrecognized to kidney damage.
It is essential that the body maintain a proper acid-base balance. The problem of regulating acid-base balance is essentially one of preventing alterations in hydrogen ion concentration secondary to the continuous formation and expulsion of the acid end products of metabolism.
The acidity of a solution is determined by the concentration of hydrogen ions. Acidity is conveniently expressed by the symbol pH. Neutral solutions have a pH of 7. The pH of a strongly basic, or alkaline, solution may be as high as 14, while that of an acidic solution can be less than 1. The pH of extracellular fluid in health is maintained at a slightly alkaline level between 7.35 and 7.45. To prevent acidosis or alkalosis, several special control systems are available in the body: (1) All the body fluids contain buffer systems which prevent excessive changes in hydrogen ion concentrations. (2) The respiratory center is Stimulated by changes in the carbon dioxide and hydrogen ion concentrations to alter pulmonary ventilation, which affects the rate of carbon dioxide removal from bodily fluids. Since carbon dioxide forms a weak acid in solution, its removal lowers the hydrogen ion concentration. (3) The kidneys also respond to changes in hydrogen ion concentration by excreting either an acid or an alkaline urine.
These control systems operate together in the maintenance of the body fluid pH. The buffer system can act within a fraction of a second, whereas the respiratory system takes one to three minutes to readjust the hydrogen ion concentration after a sudden change. The kidneys, although the most powerful of, all, acid-base regulatory systems, require from several hours to a day to readjust the hydrogen ion concentrations.
A solution that has a tendency to resist changes in its pH when treated with strong acids or bases is called a buffer. A buffer solution contains weak acid or base and a salt of this acid or base. In biological fluids the bicarbonate-carbonic acid system, the phosphate system, the hemoglobin-oxyhemoglobin system, and the proteins act as the principal buffers in the regulation of pH.
The sodium bicarbonate-carbonic acid buffer system is present in all bodily fluids. It should be noted that carbonic acid is a weak acid; that is, it binds its hydrogen ions strongly. If a strong acid (one that is loosely attached to hydrogen), such as hydrochloric acid is added, it reacts almost immediately with the bicarbonate to form carbonic acid and sodium chloride. The system operates by changing the strong acid into a weak acid and successfully prevents a major change in pH. The fact that the carbonic acid can easily be reduced to carbon, dioxide and water and removed from the body through respiration greatly enhances the combined efficiency of these mechanisms in responding to changes in hydrogen ion concentration.
If a strong base such as sodium hydroxide is added, the carbonic acid reacts immediately with it to form sodium bicarbonate and water. Again the buffer mechanism has prevented a major change in pH by changing a strong base into the less alkaline sodium bicarbonate.
When an excess of sodium bicarbonate and calcium carbonate is present, abnormal alterations in acid-base balance occur, resulting in a state of alkalosis.
Another type of antacids given to peptic ulcer sufferers is the nonabsorbable antacids. These antacids are relatively insoluble salts of weak bases. Suspended antacids present a large surface area of interaction with hydrochloric acid; this activity forms nonabsorbed or poorly-absorbed salts, thereby increasing gastric pH. The activity of pepsin diminishes as the pH rises above 2. Complications can also arise here, too, when there is such interference with acid-base balance and continued use can also result in alkalosis although not as quickly.
Aluminum hydroxide is another antacid commonly used. Phosphate depletion may develop as a result of binding of phosphate by aluminum in the gastrointestinal tract. Symptoms include anorexia, weakness and malaise. If there is bone resorption to compensate for phosphorus loss, urine calcium raises and there may be bone pain. If depletion is sufficiently severe and continues over years, osteomalacia may develop. Aluminum hydroxide also binds fluoride and this too may contribute to osteomalacia.
Since calcium and phosphorus are intimately related in metabolism, two ratios between them are significant. (1) the dietary calcium to phosphorus ratio affects absorption of these minerals; for adults a 1:1 1/2 ratio of calcium to phosphorus is required. (2) the serum calcium to phosphorus ratio is the solubility product of the two minerals in the serum.
An increase in one mineral causes a decrease in the other to maintain a constant product of the two. The normal serum level of calcium is 10 mg. per 100 ml.; of phosphorus, 4 mg. per 100 ml. in adults.
If this ratio is unbalanced, the body will compensate by drawing on its stores to compensate. Therefore, an excess of phosphorus will result in the withdrawal of calcium from body stores—which may come from the bones.
Magnesium salt is frequently given to people with ulcers in spite of the fact that it often results in diarrhea. This is a clear indication that the body cannot utilize this inorganic mineral and finds a way to quickly dispose of it.
Anticholinergics impede the impulses or action of the fibers of the parasympathetic nerves. They are given to delay emptying of the stomach and thus prolong antacid retention. These drugs often result in dry mouth and blurred vision.
Upon administration of this type of drug, a worse condition is immediately incurred. With delayed emptying of the stomach, fermentation and putrefaction of food materials are very likely to occur. This results in the liberation of extremely toxic by-products of this decaying process. The end result is a worsening of the toxicosis that is already present in all peptic ulcer patients. We should strive to eliminate toxicosis and certainly do nothing to contribute to it. Why should you compound a problem by ingesting these toxic substances? You are immediately creating two problems: First, the addition of toxins from the drug itself and second, the interference of that drug with normal bodily processes.
2.6.3 Histamine h3 Receptor Blocking Agents
Many physicians use histamine h3 receptor blocking agents. Histamine is widely distributed in tissues, the highest concentrations are in skin, lungs and stomach. The specific homeostatic function of histamine remains unclear. Its actions in man are exerted primarily on the cardiovascular system, extravascular smooth muscle, and exocrine glands, and they appear to be mediated by two distinct histamine receptors, termed H1 and h3. The effects of histamine h3 receptor in the exocrine glands is to stimulate gastric acid secretion. The drug Cimetidine is given to patients with gastric ulcers to block the stimulation of gastric acid by histamine and thereby reduce gastric acidity. Being a new drug, its toxic effects have not yet been proven but we know that all drugs are toxic and interference in any bodily function is contradictory. Again, this drug does nothing but suppress symptoms and causes are not even given a thought. There is no “cure” with cimetidine. In some cases the ulcers will temporarily heal, but will reappear because the same conditions that resulted in the ulcer in the first place still exist.
2.7 Requirements To Heal Peptic Ulcers
REST. That is the main requirement. When the stomach is given to a total rest, the ulcers will heal. During the first two or four days, there will be some pain but soon the gastric juices will subside and there will be no pain after that for the remaining of the fast. Dr. Shelton found this to be true for the many people who fasted under his supervision with gastric ulcers. This is the most effective, surest, and safest way to attain proper healing. When this method is employed, there will be no recurrences. Following the fast, however, old habits must not be resumed. Smoking, alcohol and coffee drinking must be eliminated and a healthful diet must be adhered to. In addition to this; an exercise program should be initiated and the other requirements for health met for optimum health.