Digestive distress

Q My husband is a healthy 57-year-old vegetarian, a regular exerciser, takes vitamin supplements and eats mostly organic food. Four weeks ago, for the first time in years, he had to take a week off work due to a virus that left him exhausted and with no appetite. He got over the exhaustion, but has been left with an upset stomach. He awakens at night with dreadful acidity. He cannot face food during the day as it actually gives him a stomachache, and just about manages an evening meal, but eats little for fear of awakening in the early hours.

He has been taking natural yoghurt and drinking chamomile tea for two weeks, but to no avail. Our GP has prescribed gastroresistant omeprazole tablets ‘to replace the stomach lining’, but I am most concerned about the side-effects.

For two years, we have both been taking apricot kernels daily. He does take more than I do, and I just wonder if they could be the cause of the problem. I also need to repeat that he has never had any previous stomach problems and this is really dragging him down. Do you have any suggestions? – G.B., via e-mail

A Omeprazole, a proton-pump inhibitor, is an antacid commonly prescribed to people with conditions related to excess stomach acid. Strictly speaking, it is not correct to describe the drug as able ‘to replace the stomach lining’. It decreases the amount of stomach acid produced, thus allowing the stomach lining to heal.

Paradoxically, a number of the reported adverse reactions with omeprazole are linked to the digestive system, the very area on which it’s supposed to work. These side-effects include nausea, vomiting, constipation, diarrhoea, flatulence, acid regurgitation and gastrointestinal Candida.

Stomach acid, while causing problems in excess, is necessary for killing harmful bacteria that could lead to infections. By suppressing the production of gastric juices, omeprazole allows these noxious microbes to flourish, leading to greater likelihood of developing gastroenteritis.

Researchers in Nottingham analysed 211 cases of Campylobacter infections reported to the Nottingham Health Authority during 1992-1994. They found that patients who were one month into their omeprazole regime had a tenfold higher risk of infections of the stomach and intestines. But this increased risk was not associated with former users (those who had stopped taking the drug), suggesting that not taking omeprazole might reduce the risk of such infections (BMJ, 1996; 312: 414-5).

Perhaps a more worrying aspect of omeprazole is that it may mask early signs of stomach cancer. These patients often display characteristic symptoms of dyspepsia that can alert doctors to the diagnosis. Endoscopy would be able to determine whether the problem is due to an ulcer or to cancer. However, controlling the dyspepsia with powerful antacids such as omeprazole could allow both the patient and practitioner to underestimate the importance of the early stomach symptoms (BMJ, 1998; 317: 1606-7).

There are things you can do to help regulate the production of stomach acid. These include avoiding anything that contains cow’s milk and any dairy products made with carrageenan. Milk, which was once the remedy of choice, has now been recognised as an acidifying food that can stimulate the secretion of even more stomach acid.

Carrageenan is a thickening agent, derived from red seaweed, that is commonly used to stabilise milk proteins in dairy products such as ice cream, cottage cheese and yoghurt. Animal studies have shown that carrageenan can damage the intestines, and result in an overgrowth of the wrong sorts of bacteria in the gut (Ann Clin Lab Sci, 1991; 21: 258-63). The natural yoghurt that your husband consumed for two weeks may have contained carrageenan, which would explain why it did not alleviate his symptoms as expected.

If your husband has already finished his course of omeprazole, he should take a good probiotic to repopulate his gut with ‘good’ bacteria such as Lactobacillus acidophilus. But avoid probiotic yoghurt drinks, as these may contain carrageenan as a stabiliser, and take them in other supplemental forms instead.

He should also keep on drinking the chamomile tea, as it can be very calming to an inflamed gastrointestinal tract. Other herbal teas that are particularly soothing for the gut and supportive of good digestion are meadowsweet, peppermint, aniseed, caraway, slippery elm, liquorice and ginger.

To help accelerate the healing of his stomach lining, supplement his diet with antioxidants. There is substantial evidence to support the benefits of vitamins A, C and E, and fish oil [1.8 g of eicosapentaenoic acid (EPA) and 0.9 g of docosahexaenoic acid (DHA) helped patients with Crohn’s] in patients with various gastrointestinal disorders.

One study found that patients with peptic ulcers showed marked improvement (reduced ulcer size and ulcer healing) after consuming high levels of vitamin A (50,000 IU) three times a day for four weeks (Acta Physiol Hung, 1984; 64: 379- 84). Another trial involved patients who had symptoms of painful digestion, proven chronic gastritis and were confirmed carriers of Helicobacter pylori. These individuals were given a dose of 5 g/day of vitamin C. After one month, 30 per cent of these patients were completely free of their Helicobacter pylori infections (Eur J Cancer Prev, 1998; 7: 449-54).

While it’s good that your husband already has healthy eating habits, it’s important to be even more vigilant about what he eats, especially as his digestive system is rather delicate at this time. It may be worth checking to see if he has any hidden intolerances to certain foods. What may have caused only a slight discomfort in a healthy stomach may now be causing a lot more damage.

Steam, broil or bake instead of frying foods. Greasy meals can irritate the GI tract. An allergy-free diet (eliminating the most common allergens: dairy, egg, corn, chocolate, wheat and other gluten-containing foods) can markedly improve the symptoms of a number of inflammatory gut disorders such as Crohn’s disease.