Ulcers Are Made, Not Born
( Originally Published 1956 )
Too OFTEN the man in the gray flannel suit acquires another badge of his high-tension, deadline-happy profession of advertising—the peptic ulcer.
Dick Elliot was a Madison Avenue veteran who had learned all the angles. We were having luncheon together to celebrate his promotion. He was the new vice-president of his company.
"I got tired of being just an ordinary huckster," he told me, "and decided I'd specialize. So, while the other guys relaxed over at the Ad Lib or the Pen and Pencil, I'd grab a sandwich and work at my desk, perfecting layouts."
He finished his second double martini, lit a cigarette, and looked around for the waiter.
"Don't you think we'd better order lunch?" I suggested.
"Hey, we're celebrating!" he said. "We can eat any time—if we get around to it. Sometimes I never quite make it."
"What about breakfast?" I asked. "Do you eat a good breakfast to make up for skipping luncheon?"
"Sure." He laughed. "A real husky breakfast. Coffee and cigarettes."
"I could tell you," I said, "that by not eating breakfast, you leave the gastric acids with nothing to work on except your stomach tissue, and that you should never douse those raw digestive tissues with alcohol—only you're not in the mood to listen."
"I'm in the mood to drink and be merry," said Dick. "Waiter, how about some more martinis!"
This was another meal that Dick never got around to eating.
By the time our food was set before us his face was beaded with perspiration, and he was doubled over with pain.
"Sorry," he mumbled, "but you'd better get me out of here. This pain . . . it's awful . . . like a white-hot coal searing my stomach. What do you think—?"
I didn't have to think. I knew. Dick was having his first real ulcer pain. His celebration ended with a trip to the hospital.
Few can escape the results of a certain combination of stresses.
Dick had become one of the sixteen million Americans—about 1 in every to—who succumb to emotional pressure. What can we do to stop this inner gastric distress, compounded by the multiplying complexities of modern living in both business and home?
Madison Avenue doesn't have a monopoly on the duodenum-scarred veterans of the hydrochloric acid war. We find them among lawyers, brokers, bus drivers, teachers, actors, and sandhogs. No occupation offers immunity. Advertising men seem to reach their breaking point sooner and more dramatically, however.
The idea that there are certain ulcer-free occupations has been disproved in studies made at the University of Southern California. The ulcer, which used to be considered the banker's and advertising man's ailment, is anything but snobbish. Personality factors contribute more to the onset of the ulcer than occupation.
The tension-tested chairman of the board of Ruthrauff and Ryan, F. Barry Ryan, Jr., says: "We are all living today under greater strain than ever before. But with all of that, there is considerable individual difference as to the way we react to tension."
Dr. Lucian A. Smith, of the Mayo Clinic, in Rochester, Minnesota, defines the ulcer personality: "The ulcer type ... is an individual of restless temperment, conscientious and possessed of a lot of drive. Although he may be a high-powered extrovert, the man with the ulcer personality is more often the silent worrier—a man who tends to bottle up his troubles. The man who `always has a grip on himself and his emotions' most often runs the risk of ulcers."
Ulcers find their most fertile field in men who carry bur-dens of responsibility. Dr. Andrew C. Ivy, of Chicago, who wrote a fourteen-hundred-page text on The Peptic Ulcer, says: "I have learned how to forget and throw off responsibilities, in the same way as I've learned to shoulder them. I have always said that I think I know enough about the cause of the peptic ulcer to be ashamed of myself if I got one."
Others doctors are not so fortunate. During a recent conference on gastric diseases it was found that 18 per cent of the doctors participating were ulcer sufferers.
Susceptibility to peptic ulcer may be with you at birth, according to Dr. Charles Baron, of Covington, Kentucky, who tells us: "In peptic ulcer individuals, there is an area of sensitive tissue potential which is subject to physical, neurogenic and psychological stress."
The type of environmental stresses that cause bodily alarm reactions and that prey on the body's tendency to ulcers are shock, surgery, fatigue, and emotional stress. Dr. Baron believes that, by revising their outlook on life and their reaction to tension, many potential ulcer sufferers could avoid this fate.
Among primitive peoples and in the mentally defective, ulcers are almost unknown.
It was revealed by a panel of four specialists, in Grand Rapids, Michigan, that 40 per cent of American executives suffer from ulcer symptoms at one time or another. It is the 10 per cent who ignore these symptoms who invite chronic ulcers. Steps must be taken, through medication and a revised way of life, to stop the body from producing an unsound amount of hydrochloric acid, which happens under stress.
By eliminating the causes, about 85 per cent of all ulcer sufferers can prevent further ulcers and treat the ones they already have. The other 15 per cent, including those who won't follow the rules for better living and those who fail to respond to treatment, require surgery. Ulcers are definitely made, not born.
Just what is a peptic ulcer? It's an open lesion, or sore, on the wall of the stomach, left after erosion of the stomach lining. This erosion is caused by the presence of an over-supply of hydrochloric acid in the gastric juice over a period of time. The acid irritates the lining and produces some erosion. Then the digestive juices begin to digest the affected area of the stomach, making a larger and larger crater. It isn't only what you eat that causes a stomach ulcer—it's what "eats you," as well!
Dr. Lester R. Dragstedt, professor and chairman of the Department of Surgery at the University of Chicago Medical School, agrees with this explanation, his studies indicating that ulcers result from excessive acid secretion. His evidence points to bad nerves as the cause. The body's telegraph system fails to signal the brain for a halt to the delivery of gastric juices to the stomach. He further tells us: "The amount of free hydrochloric acid secreted at night by duodenal ulcer patients is from 3 to 20 times that found in normal persons."
Such mental factors as constant stress, strain, overwork, or excitement cause the glands which produce this acid to work overtime. The brain and nervous system become too fatigued to shut them off. Stomach ulcers occur more often in the duodenum—the portion of the intestine immediately attached to the stomach, into which the stomach contents are first discharged—than in the stomach itself. Ulcers of the stomach and duodenum are often called peptic ulcers.
The prominent people who have suffered from ulcers are numerous. Two Northwestern University physicians point out that Napoleon had an ulcer—which accounted for his classic pose. By putting his hand inside his blouse and pressing it against his stomach, Napoleon was able to lessen the pain. In Napoleon's day ulcers were not recognized as such by medical men.
The symptoms of ulcer are pain or heartburn, high up in the abdomen. These pains usually come one to two hours after a meal, and, in the early stages, can be relieved by more food. The pain often comes during the night and awakens the sufferer from sleep; it appears most frequently when the stomach is empty and the high acidity is unneutralized by food.
Fatigue, anxiety, and emotional strain are apt to precipitate the attacks. Never, under any circumstances, resort to taking an alkali, bicarbonate of soda for example, as this induces the stomach to produce more acid!
The man who drives himself needlessly and worries endlessly may become the anxiety-ulcer victim. Unless he changes his high-tension routine to a more tranquilizing one, he may end up with a hemorrhaging ulcer.
The physical cause of the ulcer pain is small—often a lesion no bigger than a child's fingernail. Dr. Burrill B. Crohn, gastroenterologist at New York's Mt. Sinai Hospital, says that peptic ulcers usually range from dime-size in the duodenum to quarter-size in the stomach itself. Hemorrhaging ulcers are the ones which require surgery.
Dr. Harvey Cushing, the great brain specialist, said: "Tension stimulates the dime-sized hypothalamus in the base of the brain and it courses down the involuntary nervous system to make mischief with the stomach and its secretions of acids."
Whether or not you get an ulcer depends on your nerves' control of the hydrochloric acid secretions in your stomach. Your nerve-cell energy is your body's capital, upon which you draw for the business of living. It sustains all your bodily processes, including your metabolism and your digestion.
Some of us are born with enough capital to carry us through life without going into the red. Nature has provided for the times when circumstances force us to draw heavily on our energy capital. But if overwork and tension force you to continue calling upon this reserve without replenishing it with sufficient food, rest, and recreation, you breed ulcers.
Dr. Torbjoern Oskar Casperson and his associates at the Nobel Institute in Stockholm recently announced that he had been able to demonstrate a profound chemical difference between a single living cell taken from the nervous system of a person who was tired and a cell from one who was rested. The depletion of energy changes the chemistry of the neurons.
So much depends on what the patient himself does that I must emphasize his role in the treatment and prevention of ulcers. Prevention is the best cure. You cannot cure peptic ulcers until you find a way to prevent their recurrence.
Psychological changes in the environment should go hand in hand with the treatment. First, determine your own ambitions. Don't worry yourself into an ulcer because you're buying a big house you can't afford or a new car you don't need—living beyond your means just to keep up with the well-known Joneses. Eliminate as completely as possible any conflicts, social maladjustments, or frustrations a nagging wife.
I don't mean that you should eliminate your wife—only her nagging! By any reasonable—or, if necessary, unreasonable —method. Blow your top if you must. In fact, that would benefit your ulcer.
Again I quote Dr. Charles Baron: "Bottling up your emotions creates greater stress, and frustrations are therefore more conducive to ulcers than violent expressions of moods. Stress triggers off destructive forces in the ulcer area."
The next time I saw Dick he was home from the hospital, feeling sorry for himself and worrying over his illness.
"What am I going to do now?" he asked. "Be an invalid for the rest of my life?"
"The first thing to do," I said, "is to change your frame of mind. An uncomplicated ulcer can start healing in a matter of weeks—but only under favorable conditions. You may have to replan and regulate your life. You must have calm and freedom from stress. A peptic ulcer is a chronically recurring condition when it's aggravated by mental, emotional, and physical strain."
"That's a big order," Dick said. "Where do I start?" "Right where you are," I said. "Quit worrying about your ulcer. Stop being so fiercely competitive. Avoid overwork and tension as much as possible. If necessary, change your job." "Change my job!" Dick said. "Why, I've struggled for years to get where I am. I'd just barely made it when this damned ulcer got me down. And now you tell me to give it up!" "Don't get so excited," I warned him. "I said if necessary.
Maybe it won't be necessary, if you can make a few adjustments in your life."
"Such as what?" he asked.
"Malnutrition," I said, "often accompanies a nervous, high-strung disposition such as yours, Dick. Start eating regular, nourishing meals—instead of drinking them. You can't substitute alcohol and coffee for food, as you often do, without suffering from ulcers, nervous disorders, vitamin and mineral deficiencies, and other illnesses."
"All right," said Dick. "So I mustn't drink, and I must eat. But what? A monotonous milk and cream and boiled-egg diet?"
"Not any more," I said. "That's what doctors used to give ulcer patients years ago. But now they know that such a stringent diet weakens the patient. They know, too, that eating so much milk and cream caused 8o per cent of the ulcer patients to suffer seriously from hardening of the blood vessels and atherosclerosis."
Doctors have recently conceded the fact that many persons suffering from angina pectoris and the killer coronary thrombosis had been exposed to prolonged dietary treatment for ulcers. The diet restrictions of ulcer patients have always created more need for the fat- and cholesterol-dissolving B vitamins choline and inositol.
"The old-fashioned ulcer diet," I said, "did more harm than good. You need the complete protein foods to neutralize the excess stomach acid and speed up the healing. I recommend broiled steaks, chops, and eggs. You're probably deficient in blood serum protein; most peptic-ulcer patients are."
The late New Yorker editor Harold Ross was given the benefits of a liberal diet when he came under the care of Dr. Sara M. Jordan, chief of gastroenterology at the Lahey Clinic in Boston. Dr. Jordan believes that an ulcer sufferer can have plenty of delicious foods, ranging from lobster, properly prepared, to toothsome desserts.
Dr. Daniel T. Quigley, of Omaha, in an article in The Nebraska State Medical Journal on the prevention of recurrence in peptic ulcer, says: "The ulcer patient often suffers from a dietary deficiency—not only multiple deficiencies, but deficiencies in varying degrees of all the necessary vitamins and minerals. Peptic-ulcer patients are starved, generally and specifically. . . ."
Nerve disease and the ulcer have common causes—an over-supply of refined carbohydrates in the diet. A person eating too many carbohydrates suffers a dangerous reduction in the vitamin and mineral concentration needed in the blood stream for optimum health.
"I certainly feel deficient," said Dick, "in every way, physically and mentally. What I'd like is a drink to pep me up." "All right," I said, "you can have a cocktail--"
"What?" Dick almost shouted.
"A cabbage-juice cocktail," I told him.
"Now, that," Dick said mournfully, "is an awful joke to play on me."
"It isn't a joke," I told him, but a fact. Cabbage juice is the best single food known for the treatment of ulcers. It was introduced just a few years ago, and since then doctors have reported miraculous results with it. One San Francisco physician, Dr. Garnett Cheney, said that the patients he treated with cabbage juice experienced healing of their ulcer craters in three weeks—and didn't have to be confined to their beds! Up to then, with the usual medical therapy—bed rest, strict diet, and various drugs—the average healing for ulcer craters had been six weeks."
"I always thought," said Dick, "that cabbage was bad for the stomach."
"So have lots of people," I said. "But Dr. Cheney's treatment is based on the theory that one cause of ulcers is a lack of the so-called vitamin U."
"Vitamin who?" asked Dick.
"Vitamin U," I said. "Cabbage juice is rich in it. And all gastric ulcers as a group, including small, large, or huge lesions, tend to heal completely and relatively fast with vita-min U therapy. Besides, cabbage juice is so rich in many other vitamins and minerals that it's a good substitute for fruit juices and other irritating foods which are often eliminated from ulcer diets."
According to Dr. Cheney, only 3 out of 65 ulcers failed to heal under his cabbage-juice regimen. In the three failures the causes were dense scar tissue, which had replaced the normal lining of the stomach wall, and severe liver damage.
"So I must eat regularly, drink cabbage juice, and cultivate peace of mind," said Dick. "Anything else?"
"Yes," I said. "Stop being so doggedly ambitious. Eat adequately and rest enough to avoid the fatigue which causes you to lose control of the secretion of gastric juices. Be sure that the acid doesn't pour into your stomach with no food there to neutralize it. Keep milk and crackers handy to ease the worst of the ulcer `hunger pains.' Have a jar of skim, milk in your bedroom and office. It dissolves instantly in water, tastes like fresh milk—and will forestall a painful attack."
Four to six glasses of milk a day are required in the ulcer diet. But whole milk, while it soothes your ulcers, encourages more fat and cholesterol in the blood stream. Powdered skim milk costs much less than fresh whole milk, and will keep anywhere, indefinitely. Use it to improve the flavor of and to add protein, vitamins, and minerals to all your ulcer-soothing dishes and other foods.
"Powdered milk," said Dick. "I'll make a note to buy it by the case—the way I used to buy Scotch."
"You'll probably need a vitamin C supplement," I said, "to replace citrus juice. A deficiency of vitamin C contributes to ulcers, and the vitamin is essential in their treatment."
The hemorrhaging of stomach ulcers causes peptic-ulcer sufferers to become anemic. An iron-rich, blood-building supplement is certainly indicated, if the anemia is of the nutritional kind. It would be advisable to have your doctor determine this. It is quite important. Plenty of meat, fish, cheese, and other protein foods is called for and, of course, use a good balanced vitamin-and-mineral supplement for its all-around nutritional value.
The ulcer sufferer often becomes so malnourished that he has to be given predigested protein in the form of amino acid concentrates. It is the amino acids that build the new tissue necessary to fill in the raw, craterlike sores made in the stomach lining. Astonishing work has been done with amino acid treatment by Dr. Co Tui, brilliant Chinese research scientist at New York University.
Amino acids are nothing more than food protein broken down into the form in which the human cells can utilize it. This conversion of protein food into the amino acid building blocks is a regular part of every digestive process.
"What about other vitamins?" asked Dick. "Do I need them, too?"
"I'd suggest," I said, "a balanced vitamin-and-mineral supplement, in addition to your nutritious diet. You need all the essential vitamins and minerals to keep you in optimum health."
It takes optimum health to fight an ulcer and to overcome the personality deficiencies that produced it.
"Certain foods soothe the ulcerous tract," I went on. "A famous San Francisco herbalist, Dr. Otto Mausert, found that a tea made from fenugreek seeds is ideal as a soothing beverage in ulcer diets. Russian medical men have been treating stomach ulcers with honey, which is a predigested food. The Russians have also alleviated ulcers with a cereal made from millet seed."
"It's funny," said Dick, "but I never realized that the Russians had ulcers. I thought they just gave them!"
"Your ulcer won't remain healed, Dick," I said, "unless the cause is removed. Get rid of the cause and prevent a relapse."
"I think you've shown me what I must do," said Dick. "And, to show my appreciation, I want you to go somewhere and have a cocktail with me."
"A cocktail?" I asked. "But, Dick--"
"Now, don't you get excited," he said. "I mean a cabbage-juice cocktail, of course!"