6 Things I Learned About Ulcers

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Halfway through February, I could no longer sleep through the night. At 2 a.m., I’d find myself chugging milk from the carton to extinguish a fire at the top of my rib cage. The gnawing feeling high in my stomach alternated with nausea so arresting I kept a bucket next to my laptop and considered taking a pregnancy test, even though I was 99 percent sure I wasn’t expecting.

One day on the subway platform, I doubled over and let out a groan so pathetic it prompted a complete stranger to ask, “Are you all right?” Then I knew it was time to seek medical attention. New Yorkers don’t address strangers on the subway, I told myself. It’s like breaking the fourth wall.

The next day, my primary care doctor told me I probably had an ulcer, a raw spot or sore in the lining of the stomach or small intestine. Here are some of the things I learned about ulcers during the odyssey that followed.

■ Anyone Can Get an Ulcer. Back in the 1980s, when doctors and most everyone else thought psychological stress or spicy foods led to ulcers, two Australian scientists discovered that the main culprit was actually a bacterium called Helicobacter pylori. That discovery eventually won them a Nobel Prize in 2005, and ushered in an era of using antibiotics to cure ulcers.

But that didn’t wipe out ulcers altogether. Far from it. Indeed, my tribe of fellow sufferers are legion. Nearly 16 million adults nationwide reported having an ulcer in 2014,according to the Centers for Disease Control and Prevention’s National Center for Health Statistics. The largest group, roughly 6.2 million, were 45 to 64 years old. Those 18 to 44 accounted for 4.6 million, 65- to 74-year-olds for 2.6 million, and those 75 and older for 2.4 million.

I got a blood test to see if I was infected with H. pylori; the test came back negative, so I didn’t need antibiotics. Regular use of nonsteroidal anti-inflammatory drugs, like ibuprofen or aspirin, can also lead to an ulcer, but I wasn’t taking those medicines. My ulcer turned out to be “idiopathic,” which is a fancy way of saying that doctors have no idea why it happened.

■ It Takes Time to Figure Out What You Can Eat. My doctor told me I needed standard therapy: Take omeprazole, an acid-suppressing drug, for a month to give the open sore in my stomach time to heal. While some untreated ulcers start bleeding heavily or require surgery or hospitalization, he assured me I’d feel better soon.

In the meantime, I needed to figure out how to get nourishment. But having an ulcer, I’d learned, is like being a contestant on a twisted game show called “What to Eat?”. Choose poorly, and my stomach would burn like lava, leaving me listless. Choose wisely, and I’d be rewarded with a momentary reprieve, until hunger struck again. Every few hours the “game” would start over.

Maddeningly, I wasn’t sure which foods might be safe to eat until I tried them. For instance, why did a seemingly innocuous bag of salted peanuts lead to agony?

The truth is gastroenterologists don’t know why certain food causes indigestion and heartburn for patients with stomach ulcers. There are a few rules of the road: Avoid alcohol, or anything with caffeine or high in fat.

Fatty foods “sit in the stomach for a long time and fester,” said Lori Welstead, a registered dietitian who works at the digestive disease center at University of Chicago Medicine. Perhaps that was the trouble with peanuts?

Dr. David Y. Graham, a past president of the American College of Gastroenterology, perhaps summed it up most succinctly, “There’s a general rule: Don’t eat what hurts you.”

Ulcer patients must serve as their own guinea pigs, experimenting on their guts until they find sustenance that doesn’t come with a side of discomfort for them. I didn’t realize that until weeks after my diagnosis.

■ An Empty Stomach Won’t Help — and Probably Will Hurt. Like a heartbroken soul who swears off dating to avoid future pain, I started eating less and less. So did Megan McMillen, a nurse in Morgantown, W.Va., after she discovered she had an ulcer around Valentine’s Day.

“You’re scared if you eat something what the consequences will be,” she said, so she quit eating for two days. But the downside of hunger was nausea — and an empty stomach can be doubly painful.

Without any food in there, the ulcer is bathed in stomach acid all the time, said Dr. David Greenwald, the director of clinical gastroenterology and endoscopy at Mount Sinai Hospital in New York. “It’s a really common thing people report that when they have an ulcer, any food makes it transiently better.”

■ Don’t Eat at Bedtime. Another big mistake: eating just before sleep, said Dr. Graham, a professor of gastroenterology at Baylor College of Medicine in Houston.

“If you want pain at nighttime, eat at bedtime,” he said. That’s because when you eat, your stomach makes a lot of acid to digest the food. But “once the food is gone,” he said, acid levels remain high. A result: You’ll most likely be jolted awake by pain.

■ Don’t Worry About Acidic Foods. I had never trusted Dr. Google before, but I was desperate. So I found a pH chart online that laid out which foods were acidic no-nos, which were neutral, and which were alkaline, so supposedly not as acidic in the stomach. The lower the pH, on a scale of 3 to 10, the more acidic the food, and the more I should avoid it, the chart told me.

This little rainbow chart became my bible. I cut out goat cheese, canned tuna, beef, pork and all nuts except almonds, which were rated as alkaline. My go-to meal became a whole avocado paired with a pound of strawberries.

Sadly, it took a full week for this so-called health reporter to even ask whether my pH chart or any of the many other food charts online were backed by reputable research.

Ms. Welstead, the Chicago-based dietitian, set me straight. “The pH of foods is not evidence-based for nutrition therapy or in the medical field,” she said. “Stomach acid is so so acidic, the foods you’re eating are not necessarily going to affect that stomach acid.”

The bad news was I had fallen down a rabbit hole of misinformation. I felt a little better after talking to Laurie Keefer, a health psychologist who specializes in digestive diseases at the Icahn School of Medicine at Mount Sinai, who told me her patients with ulcers often feel “out of control.”

Dr. Keefer advised me not to amplify distress by “trying to control things that probably aren’t going to move the needle on your symptoms.” Like hokey pH charts.

■ Don’t Discount Stress. “There’s absolutely no evidence that psychological stress or anxiety causes an ulcer,” Dr. Greenwald said. But, he and other experts caution, stress may make symptoms worse.

“If you have some discomfort from an ulcer, and on top of that you have anxiety and stress maybe over having the ulcer, your symptoms may actually be a little bit more pronounced,” Dr. Greenwald said.

In fact, “there is a growing adoption of behavioral health specialists in gastroenterology practices,” Dr. Keefer said. “We actually call it psycho-gastroenterology.”

She is embedded in the comprehensive gastrointestinal program at Mount Sinai, so after patients see a nutritionist for an ulcer or Crohn’s disease or irritable bowel syndrome, they can stop in for a psychological consultation. “It’s much less stigmatizing” that way, she said.

“Stress, anxiety and worry will only slow your recovery,” Dr. Keefer said. “Stress is anything that requires the body to adapt. If you’re spending resources on your stress, your body is not spending resources on recovery.”

It took about five weeks for my ulcer to heal. So I suppose I could have a burrito loaded with hot sauce. But I’m not fully over my fear. I still haven’t forgiven a probiotic yogurt drink that set my stomach on fire in the first days after diagnosis. I’m dead sure I never will.