Stomach ulcers – stress or bacteria?

Up until the early 1980’s doctors were generally of the opinion that the cause of stomach ulcers could be traced back to stress. It appeared that they were entirely mistaken, however, when the researchers Barry Marshall and Robin Warren claimed that they could prove beyond all doubt that the cause was actually a bacterium: helicobacter pylori, to be precise. And they went to considerable lengths to prove their theory: Marshall took it upon himself to drink a glass of helicobacter culture, with the result that five days later he was showing symptoms of acute stomach infection, the last stage before development of a full-blown ulcer. Since the publication of the results of this brave scientific experiment (for which Marshall and Warren were awarded the Nobel Prize in 2005) these symptoms are no longer treated with dietary advice and stress reduction measures but rather with antacids and antibiotics. A fine and irrefutable example of scientific progress! Or maybe not…

Spontaneous healing

Not really, actually, because what is generally not known is that Barry Marshall made a seemingly spontaneous and miraculous recovery only two weeks later (1). A biopsy carried out on his stomach lining showed no traces of the helicobacter pylori bacterium. Therefore, one could certainly not be faulted for drawing an entirely different conclusion from Warren and Marshall’s experiment: that a helicobacter pylori infection does not lead to a stomach ulcer in the case of a healthy person. This conclusion actually seems much more credible given the fact that 50% of all people are infected with this bacterium at some time or other,while a much smaller percentage ever develop any complaints. In all of the medical literature I have read I have never been able to find an answer to the question as to what is required to trigger the development of an ulcer in people who carry the helicobacter pylori bacterium. Maybe the medical world is simply happy to conclude that the most effective way of treating an ulcer is to bombard it with a heavy dose of antibiotics and antacids.

Louis Pasteur and Claude Bernard

Nevertheless, I was still curious to find out why helicobacter pylori does not always lead to ill health in many cases; a fact worthy of some consideration, in my opinion. My search eventually led me to Paris in the 19th Century, a time when France produced a number of eminent biologists who would become the forefathers of modern medicine,the most famous of these being Louis Pasteur. He developed the theory that the root cause of many diseases was a minuscule living organism or ‘micro-organism’. His ‘germ theory’ or ‘microbe theory’ is one of the most important discoveries ever made in the history of medicine, one that has had an enormous influence on the way in which we treat diseases.

Not everyone agreed with Pasteur. One of the most prominent biologists of the time, Claude Bernard, had a different view on the matter. Bernard determined that what really prevents us from getting sick is our ability to keep our milieu interieur in balance. This means that it is the well-being or otherwise of our milieu interieur and not micro-organisms thatis the primary source of ill health. According to Bernard, the most important task that our body performs is in maintaining the balance of our milieu interieur, and to perform this task requires the contribution and effort of almost all of our bodily functions, including our blood circulation, respiratory, temperature regulation and digestive systems.

Stagnant water

Using Bernard’s perspective we can paint a more complete picture of how an ulcer develops: the bacterium on its own is not enough to start the trouble, there must also be something wrong in the stomach itself. The first factor that can increase the risk of infection is stagnation. Micro-organisms develop much faster in stagnant water than they do in free-flowing water. Stagnation occurs in the stomach when the lower opening, the pylorus, is closed. The pylorus is a sphincter muscle that is very sensitive to stress. In an emergency situation one of the first things that our body does is to shut down the digestive system. This is not normally a problem when the shutdown is only temporary, but protracted episodes of stress can lead to trouble. There is a reason why the bacterium that causes ulcers is called helicobacter pylorus: ulcers tend to form in the lower part of the stomach, in close proximity to the pylorus. Stress can also lead to a deterioration in the quality of the lining of the stomach. This lining houses the stomach’s immune system and it works to protect the stomach not only from excessive acidity but also from attack by bacteria. And it is common knowledge that long periods of stress can also result in the deterioration of the body’s immune system as a whole (2).

Combatting disease

It seems reasonable to conclude that protracted periods of stress can contribute significantly to the development of ulcers in various ways. However, established medical practice tends to ignore this simple fact and often goes so far as to deny the relationship between stress and ulcers, based on Marshall and Warren’s publication.

If we wish to find an explanation as to why established medical practice tends to deny the link between stress and ulcers, then we will find ourselves returning to Pasteur and Bernard once again. Pasteur was blessed with excellent social skills and had the ear of the powerful and influential in the higher echelons of society. Bernard, on the other hand,was something of a loner and not exactly endowed with marvelous people skills. He fit the mould of your typical scientist much more so than Pasteur did. In addition, Pasteur’s theory was clear-cut, easy to explain and to prove, and fast and effective: kill the bacteria and you cure the disease. It is much more difficult to demonstrate the impact that the milieu interieur has on a specific disease because it is an extremely complex system that is heavily influenced by all of our body’s regulatory systems. Effecting change is a long process that demands an effort on the part of the patient. It is no surprise therefore that Pasteur’s theory won over the minds of the political establishment, the scientific world and the public in general, while Bernard’s theory was more or less discarded. Medical science proceeded to focus its attention entirely on the search for the cause of disease and how to combat it and did not trouble itself much with such matters as promoting good health, the importance of the immune system or the resilience of the human body.

Lopsided medical science

In my opinion, ignoring Bernard’s perspective has led to lopsided medical science. One could compare the situation to that of the USA, a country that has long tried to solve one global conflict after another through the use of weapons without ever addressing the underlying social problems and impaired interrelations. These problems only became greater as a result.

10% of the population of the Netherlands now uses antacids on a regular basis. The associated costs are enormous and they have led to a marked increase in stomach and intestinal infections(4). Our current use of medicines disrupts our milieu interieur and leads to increased instances of sickness. The effects of antibiotics on our immune system are now well known and the list of medicines whose side effects include stomach problems has grown very long. In my own practiceI often hear people commenting on the failure of medical science to meet all of their needs. They are continually confronted with the tendency to repress symptoms, an over-emphasis on ‘evidence’ and protocols, a lack of attention for the needs of the individual,and a complete lack of insight into the interaction between mental and physical processes. At the moment ‘alternative’ medical practices seem to be the only ones able to offer any real alternative, so to speak. Their modus operandi is based on the protection and rehabilitation of our milieu interieur,with a focus on the person/patient as a whole. Without making any pronunciations regarding the quality of these practices or whether they can be backed up empirically, it can be said that alternative medical practices are certainly doing the job of filling the gaping hole that has been left by established medical healthcare.

Restoring health

Chinese medicine is based on a philosophy of health in which balance in all things is key. Many centuries ago the Chinese saw that disease is always preceded by an often protracted period of increasing disruption of our internal balance. That balance is described in terms of yin and yang. If all things are balanced then one can speak of an unimpeded circulation of all substances and streams of information in the body, collectively known as Qi. The unimpeded flow of Qi is considered an absolute precondition of good health. Chinese medicine treats the patient as opposed to the disease. Rather than combatting the disease, it endeavours to restore good health.

The similarities between the philosophy of Chinese medicine and Bernard’s perspective are striking, to say the least. With his concept of the milieu interieur, Bernard sought to replace the ancient Greeks’ concept of’ life force’ with a more scientific alternative. Life force is not a million miles away from the concept of ‘Qi’, and the idea of a milieu interieur can thus be seen as a potential link between modern ‘Western’ medicine and traditional Chinese medicine.

Acupuncture for the stomach

In my work I often detect stomach problems in my patients, even though most of them come to me with an entirely different complaint. Stomach problems are almost always linked to some other kind of trouble. There are many different kinds of disruptions to our internal systems that can lead to problems in the stomach. Chinese medicine describes the vulnerability of the stomach and its susceptibility to stress. That stress can be the result of emotions, nervous tension or poor eating habits. In my experience, stomach problems can be treated effectively with acupuncture. Tests on rats, for example, have shown that the electro-stimulation of two important acupuncture points can have an effect on the workings of the pylorus(3). But the treatment is not limited to the stomach alone. What I treat depends on the underlying pattern of disruptions that I have been able to identify. So, in addition to the course of acupuncture treatment itself, the reduction of stress and dietary advice also have a role to play in many cases.

Yin or yang, which is better?

I would be the last to claim that acupuncture is better than established medical practice, which, it must be said, has achieved remarkable progress in many different areas. Marshall and Warren deserved their Noble Prize. Their research was revolutionary and the results of their work has seen many people cured of extremely painful ailments. In cases where it is impossible to restore balance through a ‘softer’ approach, it is a blessing that we have access to powerful medicines, such as antibiotics. So, one cannot say that Pasteur was wrong and Bernard was right, or vice-versa. Though polar opposites, these two perspectives can in fact complement each other. They are a classic example, I suppose, of yin and yang. Viewed through my yin/yang glasses, I see the rise of alternative medicine in the healthcare sector as a natural part of the process that any system seeking balance needs to go through. It is only when both perspectives are afforded equal representation that the healthcare sector itself can be considered healthy and fully able to offer patients the optimal level of care.

1) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661189/
2)http://www.pnas.org/content/109/16/5995.abstract
3) http://www.researchgate.net/publication/255736854_Intensity-response_effects_of_electroacupuncture_on_gastric_motility_and_its_underlying_peripheral_neural_mechanism
4)http://www.rivm.nl/Documenten_en_publicaties/Algemeen_Actueel/Nieuwsberichten/2014/Mogelijk_meer_maag_darminfecties_door_maagzuurremmers

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