Hi all

I'm looking for some help/advice about my possible stomach ulcer.

I've been low carbing for 20 months now, and was feeling great on this WOE up til 2 months ago. I was going through a particularly stressful time at work (I have now left) and started getting intermittent stomach pain/soreness usually on an empty stomach.

I finally went to see the Dr in early December and she diagnosed a possible stomach ulcer (duodenal maybe). She put me on Lansoprazole, which I have been taking for nearly four weeks. I went back after 2 weeks and had a blood test for Helicobacter pylori and also a blood count. I have another appointment to see her on Monday morning for the test results.

However, since I last saw the Dr, over Christmas, despite taking the lansoprazole daily, I have had a nasty flareup with the pain and soreness, and I have woken twice in the early morning with bad stomach soreness. I have been taking additional antacids to help, and have now started to eat smaller meals more often - every 2-3 hours to help with the soreness.

Now, my questions are as follows:

1) I was under the impression that low carb diets (with restricted sugar and grains intake, etc) was supposed to help suppress H pylori. After over 1 1/2 years of low carbing, how come I have succumbed??

2) My pharmacist was surprised that I needed extra antacids on top of Lansoprazole. She thought that would be sufficient to control the acid production and pain. For the first three weeks I was taking this AFTER breakfast, then discovered it was recommended to be taken on an empty stomach. Could it be simply that I wasn't taking it properly?

3) What will a Blood Count show on a low carb diet? Should I be prepared for "unusual" results and a possible challenge from my Dr on my "unhealthy high fat/protein diet"?

Sorry this is quite long and involved. I wanted to get all the details down so any of you knowledgeable people could give me your opinions.

TIA

Katy

Hi Katy!

Without knowing more about what you've been eating on a regular basis, it's hard to offer suggestions or possible solutions to your problem. It might help if you posted some samples of daily menus. Low carbing often does help people with chronic indigestion/intestinal disorders which are often due to a sensitivity to wheat and other grains. My DH had constant problems with acid reflux and indigestion until he started low carbing. After that, he didn't have an attack for 10 months until Thanksgiving when he threw low carb out the window and his symptoms reappeared almost instantly. The help with h. pylori, as I understand it, comes from eating a lot of broccoli (a favorite low carb veggie) which has been shown to be more effective against h. pylori than most antibiotics out there.
Has your doctor ruled out all other possible causes for your stomach pain such as gallbladder or pancreas problems or is she just starting with the most likely cause?
After 20 months on low carb, I would expect your blood counts to be good, so hopefully you won't have any surprises there. HTH

Hi Lisa

Thanks for your suggestions. Well here's a typical current day's menu

Breakfast - 2 slices of bacon fried in butter, 1 egg scrambled with 1 tbsp heavy cream, fried in butter. A slice of melon or small apple or other piece of non-citrus fruit.

Lunch - Fried cheese, chicken, tuna, salmon with mixed salad leaves with caesar/italian/other low carb/high fat dressing.

Dinner - Fish, meat, poultry fried or baked with butter or cream or sauce made with cream. Two portions low carb vegs (I eat lots of broccoli - usually twice a week!), eg, cauliflower, broccoli, green beans, cabbage, sometimes a spoonful of carrots or peas.

Snacking - not much, but when I do - a couple of slices of Brie cheese or a handful of salted nuts.

I drink tea - about 4 cups a day, and coffee about 1 cup a day. I don't smoke or drink much alcohol or drink fizzy drinks. I also drink plenty of plain water!

Did that cover it?! I am interested in the idea that wheat may contribute to stomach ulcers, as I had noticed before this all blew up that I would get slight stomach cramping when eating a small piece of bread, or other item made with flour (my plan allows this occasionally), and the day that this all started, I had eaten a cheese scone in a tearoom to be sociable.

My doc did check about gallblader but was obviously not concerned about this after the examination. I feel sure it is not gallstones because I have been eating high fat for so long now if it was going to happen it would have happened ages ago! The pain happens on an empty stomach and never after eating (as with gallstones). Also I had a suspected stomach ulcer as a teenager which was eventually diagnosed as "gastritis", so I feel sure I am prone to this kind of thing. I was just surprised after so long eating a healthy low carb diet that this should happen. I would expect protection from stomach problems on a low carb WoE. My doc didn't mention pancreas. I think we are trying the most obvious thing first.

Katy

Katy...

I wouldn't go so far as to say that wheat and other grains cause stomach ulcers, but a lot of people who have had chronic reflux and indigestion along with other intestinal problems such as irritible bowel syndrome (IBS), diverticulitis, crohns disease and such have reported a great increase in relief when they cut grains out of their diets.
Low carbing is also no guarantee that you won't develop stomach problems as there are other factors that can be at work here as well such as stress and sometimes just a genetic predisposition to it. I'm not sure how often you need to eat broccoli for it to be effective against h. pylori, but I'll do some checking on it.
Whenever I've had problems with my stomach, the first advice I was given is to avoid spices, caffeine and carbonated drinks. It might help if you cut out the tea and coffee for a while or substituted an herbal tea instead. Chamomile and mint are both very soothing to an upset stomach.

Hi there Katy,

Have you had a gastroscopy to diagnose an ulcer? If you still have pain, and have not been scoped, you should ask - demand! - to be referred to a gastroenterologist for that purpose.

I suspect your doctor ordered the blood count to make sure your ulcer (if that's what it is) isn't slowly leaking a bit of blood. Ulcers have a nasty tendency to do that. Low carbing only does good things to pretty much all blood tests, so I wouldn't worry about that aspect of it.

From what I know about H. pylori, only the appropriate antibiotic will cure it. Please ask for that referral to a specialist! I personally (am an RN) don't think GPs should be trying to treat peptic ulcers without having them properly diagnosed.

I do hope all goes well for you, Katy. Please keep us informed.

Rosebud

I agree with Rosebud about going to a Gastroenterologist. I'm also a RN and I've had stomach trouble for over 20 years.

It does sound like you have an ulcer or severe gastritis. For proper treatment you need to have proper diagnosis. I think, in addition to being scoped, you should ask for a barium swallow. If you have trouble swallowing, ask for a barium tablet during the test, not just swallowing the liquid. The tests themselves are not that bad....they're improved the taste of the barium and they pretty much knock you out for the scope. I'll occasionally remember snipets....like the doc talking, nurses moving me, etc. Believe me! I had all the done over 20 yrs ago and the improvement in technique has made thing a lot easier!

When my stomach problems first started I was treated by a GP (internist) for over a year before going to a specialist. I was newly married, just bought a house and in a very bad job situation. It got to the point where I was vomiting several times a day, lost over 30 pounds and was having trouble swallowing. The first thing the GI doc did was a GI Swallow and a Gastroscopy. No ulcer, just really severe gastritis. The trouble swallowing was due to strictures caused by all the vomiting. Since then I've been on almost every stomach med there is....and the only thing that works is Prilosec. H Pylori is not present with me. It's all sensitivity and complications.

My advice?
Stop coffee, tea, all alcohol, and carbonated beverages. Also be careful with food and drink that's very hot or very cold.
Spices, tomatoes, chocolate, wine and butter (yep, but just during a flare up, and if it bothers you) as these can relax the muscle between the stomach and esophagus, increasing reflux and symptoms.
Try white pepper instead of black...weird, I know....but it really does make a difference! Twenty years ago, I couldn't eat any black pepper! White didnt' bother me. Now I just have to be careful, but always keep white in the house. I love pepper, but use it sparingly. If I make something or want something that calls for a lot of pepper I use white only.
Raise the head of your bed 30 degrees or try sleeping on several pillows so you're partially upright.
Eat small frequent meals. Try to keep something in your stomach as much as possible....but dont' eat within 2 hrs of bedtime. Avoid raw fruits and veggies....at least until you figure out if they bother you. Dairy products too. Calcium supplements, like dairy, can cause an increase in acid production, so you might want to hold those supplements for a while.
***If you have heartburn, or other pain that is relived by antacids, take the antacid! Be aware some can have a laxative effect....but otherwise they shouldn't cause any problems. The more pain you have the more potential damage. If the antacids work it's because they're temporarily soothing and repairing the inflamed area.
Take all meds (except stomach med) with food. Avoid all Asprin, Motrin, Celebrex, Vioxx, etc if at all possible. If you must take someting, make it tylenol. If this doesn't work, change your choice of med. (I can tolerate Motrin at 800mg 4X/day....but Vioxx, Celevrex, etc all destroy my stomach!) Ask your pharmacist about any meds (prescription or OTC) to see if any are known for causeing stomach trouble.
Do avoid all sugar and refined carbs. This is known to "feed" HPylori and causes an increase in acid production. The doc I see, formerly from Duke, said that after the study done there the doc in charge told him that almost all the patients with stomach troubles had relief on Atkins....and the ones that went off the plan at the end of the study complained of rapid return of all symptoms. The doc is now considering a study on the effects of carbs on patients with stomach problems.
One exception to the carbs. One or two saltines or a small hunk of bread can (and I think should) be eaten if you have heartburn and no antacid available. Again....the crackers will absorb the acid in your stomach and thereby help prevent further damage.
Drink plenty of water.

Good luck and keep us informed! I'm sorry you're having so much trouble right now! I don't think it's the low carb diet that's the problem as much as it might be some of the foods your eating now that you didn't in the past.

Cindy

Thank you all for your in depth advice! Isn't this site great??

I saw the dr again on Monday, and I don't have the h pylori bacteria. I was a bit disappointed by that because it would have meant an "easy" solution with antibiotics. My haemoglobin was apparently fine at "13.8". Anyway, she has prescribed me 20mg of Famotidine (H2 inhibitor) twice daily and 30mg of Lansoprazole (proton pump inhibitor) once a day, and also referred me to the hospital for an endoscopy. Oh well.

I'm keeping the symptoms fairly well under control, and I really think the Famotidine is helping. I don't find that tea, decaf coffee, tomatoes or chocolate particularly make it worse, although hot drinks do upset me. I have also discovered that salty and spicy food cause pain, so I am weeding out those recipes that contain those things. I've stopped adding salt & pepper to my meals for the time being, although I haven't noticed that pepper causes a problem yet. The most important thing to avoid pain is not to overfill my stomach.

Having had time to think about the cause, my take on the situation is this. As I said before, I had gastritis as a teenager, so I may well be susceptible to this kind of stomach ailment. Also, last Feb, my doc recommended that I start taking a "baby" aspirin to thin the blood (I had a minor stroke 9 years ago) and I also had an extremely stressful year at work in 2002. So, basically, I think it was caused by the NSAID combined with lots of stress on my sensitive stomach! I have stopped work and the aspirin, so I just hope it will be plain sailing to full health from here!

Katy

Interesting to read that you have reduced your intake of aspirin, Dr Mercola has published a number of reports on aspirin use, to summarise. "Aspirin May Cause More Harm Than Good" .
Here here is a link to his articles.
http://www.mercola.com/2000/jul/2/aspirin.htm
In the case of my honey she was taking "baby" aspirin most days and began suffering from inflamation of the white of the eye, for which some powerfull medications were prescribed. It was only when we researched some of the side effects of aspirin that we found that this was indeed a common side effect. She stopped taking aspirin and the problem has never come back. My point is that even a "safe" drug such as aspirin has many possible side effects and may in the long run not be as safe as we have been lead to believe.

I've been reading with interest lately about "Leaky Gut Syndrome" .... are you all familiar with it? Amazing theory to me and I have suggested to anyone with auto-immune and/or digestion problems to do a little research. I haven't found a "favorite" website that described it comprehesively...but I'll keep looking today and post some links.

Roz, I'm sure you've looked into it, havent you?

Hi Teridoodle

I found several interesting sites about Leaky Gut Syndrome. I have heard of it; it's featured in Protein Power Lifeplan. This is a good site:

http://www.forhealthsolutions.net/leaky-gut.html

I don't think it applies to me because I only have 2-3 of the dozen symptoms it lists there, and definitely no bloating, diarrhoea or constipation.

I'm still waiting for my endoscopy, but today I happened to speak to another Dr at my dr's office because I was concerned about some side effects I might be having.

He checked my notes and commented that as the Lansoprazole (proton pump inhibitor) did not appear to have cured my problem then I most likely did NOT have a stomach ulcer. Now I am wondering - WHAT IS IT THEN?? He said it could be IBS or Crohn's, maybe, but with those you get diarrhoea and/or constipation with general bowel discomfort and pain, right? I have none of that - simply pain and discomfort in my stomach area. He also pointed out that at my age it was very unlikely to be stomach cancer (I have obviously been worrying a little about this, but I feel quite well otherwise with no sudden weight loss or appetite loss and my bloods were all very good). Anyhoo, unlikely does not mean impossible ....!

Part of my anxiety is that I don't want to get into a discussion about my diet with any medical person (like at the hospital after my endoscopy). At first sight, as I am eating this "unhealthy high fat diet" and I have stomach problems, in their eyes they must be connected, right? I will emphasise my natural, unprocessed diet of plenty of fresh fruit & veg with meat, fish and chicken, but with a bit of probing, they will come across my high fat diet. I'm no good in conflict situations, despite the fact that I have read extensively about low carb over the past 2 years. I just crumple under medical scrutiny (Yes! wimp!!)

Oh dear .....

Katy

Just hang in there....they'll figure it out.

I agree with the doc that it's unlikely cancer, more likely a simple problem.

Where exactly is the pain? right under the breastbone? off to the right of left side? or is it lower in your belly? Is it intermittent? Sharp? Dull?

There are so many things it could be! Right under the breastbone could mean esophagitis, and inflamaion of the esophagus most likely due to reflux. Off to the right side, I'd go with gall bladder, especially if you followed a low fat diet prior to LC. Off to the left it could be pancreatitis or an intestinal problem. Lower in the belly it could be stomach, intestine, or even an infection somewhere. (My daughter always gets a belly ache when she gets strep throat or a bladder infection....she doesn't have any pain where the infection is)

The point is that there are so many things that it could be, and most are easily treated or cured.

I know what you mean about talking to the docs about the diet....I had the same problem in August when my doc questioned me. And so I just agreed with her and then did what I wanted to do.

I will tell you, tho....my GI doc (he's on staff at Duke, just quit an associate professor job there) is in full support of the high fat diet. He is friends with the doc that did the Duke/VA study and said that most patients had a decrease in all stomach/abdominal symptoms while on the diet and an increase when they went off.

I have GERD with a hiatal hernia and esophageal problems. He feels that this is the best diet to be following when you have stomach problems. If the doc gives you grief, agree with him and then do what you feel is right....if that's following his recomendations or not is up to you.

They probably won't talk to you much right after the procedure as you'll be pretty groggy....they'll probably tell you what they found, and make an appointment for you to go in and talk to the doc. If they do talk to you, they'll give you written instructions too.

Good luck and don't worry....it will all turn out fine. Keep us informed!

Cindy

Hi Cindy

Thanks so much for your support.

The pain and/or discomfort varies quite a bit. It's intermittent sometimes sharp and sometimes dull! There are good days and bad days. Sometimes it's a sore or pricking/stabbing sensation either in the centre of my tummy just below the ribcage, or just to the right, below the ribcage. That usually signifies that I should eat! Sometimes after eating I get a general soreness in the entire area, varying in degree of discomfort. I get no acid reflux or any bowel problems or pain and no heartburn.

I feel fairly sure that it can't be gallbladder, as I have been eating 70% fat diet for nearly 2 years, and if I had gallstones atrophied from when I was eating low fat, they would surely have made themselves known way before now!

Thanks again for the advice!

You wouldn't think, but the area you've just described is the gallbladder. Try slowly pressing in with the tips of your fingers in that area and see if you find some soreness which is limited to an area about the size of a quarter. If you do, it's the gallbladder. It is also possible you've had a small stone in there for a long time and now it's decided it's time to get rid of it. Or the duct it uses to empty out is inflamed and not allowing the gallbladder to 'dump' properly. Go poke yourself and see....(but please do it gently) It really sounds to me like the duct/outlet is inflamed. You may try lightly massaging it a bit and see if that helps relieve it. Warning: it may actually be very sore to the touch--mine was, but I was able to work out the inflammation using massage and I also took an herbal anti-inflammatory which I think also helped. I also have occasional problems with my liver ducts getting inflamed as well as my iliosecal valve (in the guts) getting inflamed. I get my massage therapist or my chiropractor to do visceral massage and it'll clear up in a couple of weeks.

Hi KJ

Well I pressed and I pressed! No pain, no nothing.

Really - my Dr already examined my stomach thoroughly, checking for gallbladder, and found no probs. Gallbladder pain usually occurs after meals, esp fatty meals. My discomfort/pain usually occurs before and between meals, and eating always makes it better. In fact, the best thing to eat to ease the discomfort, I find, is Brie cheese!

Thanks for your advice, anyhow, I appreciate it. I'm thinking it's probably Non-ulcer dyspepsia ..... and still waiting for my endoscopy appointment!