In this episode of What the Health, the focus is on ulcers, a prevalent but often misunderstood medical condition. Host John Salak and guest expert Dr. Nina Nandy, a practicing gastroenterologist with the American Gastroenterological Association, delve into the causes, symptoms and treatments for gastrointestinal ulcers. 

Dr. Nandy dispels common myths, such as the misconception that stress directly causes ulcers, and discusses the significant role of bacteria like Helicobacter pylori (H. pylori) and medications like NSAIDs. She underlines the importance of proper diagnosis and treatment, stressing the potential dangers of untreated ulcers, such as bleeding and perforation. The episode also covers preventive measures, diagnostic improvements and the importance of patient-doctor communication.

00:00 Introduction: Why Worry About Ulcers?

00:48 Debunking Ulcer Myths: Stress and Causes

01:45 Expert Insights: Meet Dr. Nina Nandy

03:45 Understanding Ulcers: Types and Symptoms

04:56 Causes and Risk Factors of Ulcers

11:08 Ulcer Symptoms and When to Seek Help

18:50 Treatment and Prevention of Ulcers

21:08 Maintaining a Healthy Stomach Lining

23:04 Common Misconceptions About Ulcers

26:23 Health Hacks and Advice

29:37 Conclusion and Thank You

Don't miss an episode of What The Health. Subscribe now on your favorite podcast app to get the latest news and insights on health and wellness issues delivered right to your device.

Connect with WellWell USA:

• Website: https://wellwellusa.com/ 
• Join WellWell-Being: https://wellwellusa.com/register/ 
• All Things WellWell USA: https://linkin.bio/wellwellusa 

Connect with the American Gastroenterological Association

• Website: https://gastro.org/ 

Connect with Dr. Nina Nandy:

• LinkedIn: https://www.linkedin.com/in/nina-nandy-md 

Tips To Avoid Ulcers with Dr. Nina Nandy - Transcript

First off, stress doesn't really create ulcers. It may make them worse, but it doesn't actually cause them. More importantly, however, is that if we don't think about ulcers, and how best to avoid them, chances are a lot of us are going to get one. The number could already actually be increasing, and running past the 1 in 10 Americans that is now used as an ulcer yardstick.

Left untreated, these stomach and intestinal lesions can cause all sorts of nasty and potentially serious symptoms and dangers. Unfortunately, It's easy to overlook ulcers, or perhaps suffer through them. So how do we deal with preventing, identifying, and treating ulcers? Fortunately, we've identified an expert on this unpleasant problem, who is more than ready to open up on the ulcer issue, its causes, symptoms, treatments, and more.

So relax, and keep listening.

All right, so welcome to really the most important section of our podcast is when we get to speak with someone who knows a heck of a lot more about the subject we're talking about than I ever do. And today, obviously, we're focused on ulcers and what they are, why they're being brought about, how dangerous are, how many people get them.

And we have a wonderful guest to help explain this and give us some insights on exactly what this means for you on a health wise. And that is Dr. Nina Nandy. She is with the AGA, which she will pronounce later because I have a tough time pronouncing the full name of the association. So Dr. Nandy, welcome to our broadcast.

[00:02:24] John Salak: Okay. And do you want to just tell everybody what AGA stands for? Cause we

[00:02:42] John Salak: Before we dive into specifically the topic of ulcers, tell us what a gastroenterologist is or what their focus is.

Because it's probably wider than what we're assuming.

So not only do we deal with all the digestive health issues, we do procedures as well. Like your regular routine, screening colonoscopy, but also more advanced things like taking out gallstones or, common bile duct stones or doing feeding tubes and dilations and whatnot.

[00:03:50] Guest - Nina Nandy: absolutely. So I think this is a great topic first of all, because it's so widely prevalent. It's something I talk about almost every day. So an ulcer at the most basic sense of the word, it's a sore or a lesion that can form. Usually in the lining of the digestive tract, typically in the stomach, we call those gastric ulcers or in the upper part of the small intestine, and we call those duodenal ulcers, but you know, you've probably heard of people with diabetic foot ulcers and things like that. So it's really, not limited to the GI tract. They usually happen when the protective lining of the GI tract is damaged in some way or eroded, which allows all the stomach acid and juice to irritate the sensitive tissues.

[00:04:41] Guest - Nina Nandy: There's definitely different types of ulcers caused by different reasons. I think today we're mainly focusing on the GI type of ulcers. But yes, you can get ulcers, on your mouth, like aphthous ulcers, cold sores are types of ulcers. Diabetic ulcers, of course, are different types of ulcers.

[00:05:12] Guest - Nina Nandy: This is an awesome question. The most common causes of GI ulcers, and since we're talking about GI, is H. pylori or Helicobacter pylori. That's a bacteria that infects the lining of the stomach and the small intestine, and that causes inflammation and weakening of the protective mucous layer. That's something we always test for. And the other more common Another common cause of ulcers is NSAIDs, or non steroidal anti inflammatory drugs. And those are things like aspirin, ibuprofen, naproxen, that can irritate the lining too. There are other causes like smoking and lots of alcohol, genetic factors.

There are some medical conditions that make you more prone to developing ulcers like Crohn's disease, Zollinger Ellison syndrome, other inflammatory bowel. And, that brings us back to the very. important and interesting concept of stress. So stress doesn't directly cause ulcers, but it makes behaviors and people who already have contribute to making them worse.

And it also contributes to unhealthy behaviors because when you're stressed, you might smoke or drink more or, have poor eating habits and that can certainly contribute to ulcer risk.

[00:06:36] Guest - Nina Nandy: and I think that's a great question, too, because reflux, or GERD, as we call it, gastroesophageal reflux disease, is something I talk about every single day. It's and it doesn't directly lead to ulcers, but it can contribute to their development, lot of important ways. So first of all what is GERD? GERD acid reflux is when the stomach acid flows back up into the esophagus maybe because the lower esophageal sphincter or that flap we have that muscle is loose or other reasons can cause it and that irritates the lining of the esophagus and so over time anytime you have chronic irritation that weakens the protective barrier of the esophagus and makes it more susceptible to damage. So You know, sometimes chronic or severe cases can lead to ulceration in the esophagus. We call that erosive esophagitis. And sometimes it can lead to you maybe have heard of a condition called Barrett's esophagus, which are some precancerous changes in the lining of the stomach. Basically the cells and they start to look more like stomach cells because they can protect themselves against acid, but the esophagus wasn't meant to do that. But, Chronic exposure can sometimes cause these all sort of changes. Acid reflux, itself doesn't directly cause ulcers, but it exacerbates, it makes conditions worse that lead to ulcer formation, especially in people who are susceptible which we'll probably talk about a little bit, like, you know, who's prone to this.

What are the causes that can lead people to develop ulcers?

[00:08:46] John Salak: there certain groups that are more at risk for developing ulcers?

But I think that's changed a lot.

[00:09:38] Guest - Nina Nandy: Yeah, that's a great question. So the prevalence of It's hard to say. So I would say in the United States, it's estimated that about 10 percent of people will develop some kind of gastric peptic ulcer at some point in their lives, which is a lot. And so that figure depends on, age, gender, other health conditions as well.

And sometimes a lot of this is under reported. People don't get it, sorted out, their symptoms or they don't get it. I don't really get medical attention, but it's is very common around the entire world.

And I mean, you mentioned smoking as a factor. I think that's declining in the States, but rising in the third world and elsewhere um, you know, do you think that's growing, getting better or worse in terms of percentage? Or prevalence,

[00:10:46] John Salak: Okay, that's that's, yeah, that's interesting. And we come across that with a lot of the issues we cover, is that the diagnostic abilities are greater or more advanced. So we're picking more of that up, which is a

[00:11:01] John Salak: Well,

[00:11:03] John Salak: there you go. And that was, and there we go. And that was my, thank you for leading into my very next question. So you're sitting there I'm, I'm sitting here drinking black coffee, my third cup of the day and talking to you. And I'm not, nervous in any way or stressed out, but what are some of the symptoms

so we know, this may be more than just. You know, as, As Oh, forget it. Whoever the guy was in the the Christmas pageant, a bad piece of pork, no, it's not a bad piece of pork. Well, how do I know I may have an ulcer?

And so sometimes, like bloating or belching feeling full Like a fullness in your upper stomach nausea vomiting sometimes loss of appetite or unintentional weight loss those are the more common things and then things that are less common, but are also very important for us to check out is if the ulcers are causing heartburn, if you're getting black sticky poops, sorry, this is a GI talk. but you know, if you have any blood, in your stool, we got to get that checked out because bleeding ulcer is a big deal. And then chronic blood loss, which you may not see, you can get very tired. So an ulcer can cause fatigue. And then also there are some ulcers that don't have symptoms. And so, you don't necessarily have to have any symptoms.

So what's a good gauge for them to say, Hey, I really need to have this checked out. And I know everybody should have all of those symptoms checked out, but is it persistent for a day, a week?

and you can say, Oh my gosh, that's, that's, that's terrible. And people go in for their annual checkups.

What? in And hopefully you're spending some time with your doctor and we've read studies that a doctor's visit is down now to 11 or 12 minutes

sometimes,

[00:14:06] John Salak: be disgusted. You will have you for another part on that.

So, they're

going, Oh,

so, our GP, I mean, I'm not bashing GPS, but are you're a primary care physician? Are they likely to investigate whether you have an ulcer unless you look like somebody who, Either has a symptom or an age factor.

How do we proactively check for that? I guess is what I'm saying.

But I do think, they do a pretty good job of, investigating the. If somebody has bad heartburn or bad reflux or this gnawing pain or weight loss, they will refer to GI or a lot of them might do like an initial test, like a non invasive test, like checking for that bacteria I talked about, H.

pylori. There's a breath test and there's also, a poop test, that they can sometimes check for.

[00:15:11] Guest - Nina Nandy: I think people should ask. People should ask about any symptom at any age, We have seen a lot of unfortunately things happen in younger younger people and a lot of times people Have been written off because you're young and healthy like that's nothing and then I'm of the firm belief that if anything's going on You're the one who deals with your body every day.

Please. Tell us let us know And we're not gonna know it unless you tell us or unless there's a concern and just say hey, you know Could it be you know? this or that. I'm concerned about this. And a lot of times if you have a good relationship with your physician, it's just a conversation and say, you know what, let's get this test and rule it out and give you peace of mind.

I'm really of the school of thought that just get it checked out.

[00:16:05] Guest - Nina Nandy: Well, you know, the risk factors of developing ulcers are generally come with age and especially because of the protective lining of the stomach. gets eroded. But I do see a lot of ulcers in younger people. I don't know if it's becoming more and more just because we're more aware of it, but certainly, you know, if you're a person who plays a lot of sports, have sports injuries, you're taking those drugs, those NSAIDs, you've had surgery, that kind of thing. I think with the appropriate risk factors, we see it more. and more. But I don't know if, just a young person without any of those risk factors would be more at risk of developing that. I think there has to

[00:16:37] Guest - Nina Nandy: know, some reason. Some reason.

Yeah.

[00:16:49] Guest - Nina Nandy: Oh yeah. Yeah. Yeah. I think, ulcers can pose a variety of risks if they're not treated. And so, it's important to get this looked at. So one thing is, what is the cause of the ulcer? If the cause of the ulcer is H. pylori, that bacteria we talked about, which is very common, right?

Yeah. That bacteria is actually, considered a carcinogen. It can cause a very rare type of lymphoma in the GI tract. So we have to treat it. And not only do you want to get that treated, you have to check for eradication, meaning, six, six to eight weeks after you're done with antibiotics, get a test to make sure that bug is gone. we want to make sure you don't have it. So it doesn't lead to that risk. And then of course, bleeding, is common with ulcers because the more erodes a blood vessel can poke through. And some of those can be really bad. They require, clipping and banding and injecting and all, and sometimes surgery.

The other thing that's really bad is a perforation or a tear. So basically, if an ulcer gets deep enough, it can kind of. Eat away and go through the lining of the stomach and then. that can cause stomach acid and digestive juice to spill into the abdominal cavity. And that can be life threatening, cause peritonitis and often require surgery. Also another bad thing ulcers can do is cause obstruction or blockage. So let's say you've got a big ulcer in the stomach located in the area where stomach goes into the small intestine. That's called the pylorus. You can get what's called a gastric outlet obstruction. So , anything you eat is not going through.

So, you're gonna get nauseous, feel bloated, feel awful. You can have persistent vomiting due to that weight loss,

[00:18:17] Guest - Nina Nandy: Yeah,

[00:18:31] Guest - Nina Nandy: so H. pylori is actually pretty common around the world and certain parts of the world are more prone It's just what we call endemic. It just lives in that area. So if you

travel you might pick it up It's also kind of a hygiene thing So if you're around people that have it and you don't wash your hands or they're preparing your food you can get that so some sometimes if I have a patient who has it You just want to make sure everybody else in the household gets checked, too

[00:18:59] Guest - Nina Nandy: So at this point, I guess we've already diagnosed the fact that a person has an ulcer, right? Like we've done an endoscopy. I'm assuming, we took a scope, we took a look. Cause it's important to take a look and I'll tell you why, because you have to know the location of the ulcer. That makes a difference. How many, how big is their blood vessels, that are involved. for Example the treatment depends on. what causes it. So if H. pylori bacteria caused it, and sometimes, we find H. pylori because we always biopsy the stomach, even though you don't have an ulcer, you want to treat with antibiotics.

So it's usually a three or four drug regimen, for two weeks. And then we test again in six to eight weeks to make sure the bug is gone. If the cause of the ulcer is taking those medications, like NSAIDs, And there are other medications, that can cause ulcers too, besides NSAIDs. then you want to, stop them if you can. And treat with medications that protect the lining of the stomach. Like, Meprazole, Nexium, your PPIs, or H2 blockers like like Zantac. But PPIs are generally a little bit better to treat ulcers. And then of course, if you have a bleeding ulcer, we go in there and put a clip on it or inject it, put hemo spray.

There's lots of other things we can do while we're doing the procedure itself. We can do it all together. and so, the treatment kind of depends on, what causes it, and whether there's complications.

[00:20:21] Guest - Nina Nandy: know.

[00:20:25] Guest - Nina Nandy: Yes. And I will tell you something that's important that I want, all the listeners to know in our GI guidelines and like I said, medicine, is a art and a science. So there's guidelines that exist for reasons, but specific. Individuals, depending on their risks or different, but usually ulcers that are in the stomach, or bad ones in the esophagus, we re scope, so we look again after, a period of eight weeks or so, to make sure that has healed.

Small intestine, not so much, but stomach ulcers in particular, even after the treatment, you want to make sure that ulcer is gone, because in some cases, a chronic ulcer that doesn't heal could be an early gastric cancer. So we just want to make sure that it's gone. Yeah. Cause gastric cancer is, is no joke and, it's something we want to make sure we can prevent. I mean, unfortunately a lot of times you can't prevent it, but, we want to make sure that ulcer is healed.

I recognize that, but are there other things you should be doing?

Are there certain foods that promote, better stomach lining? There are things that we should all be doing just to stomach lining is in better shape.

that just, makes it harder for the stomach to empty. So the longer it's sitting in there, the more acid and stomach acids trying to break it down. And then that can lead to, destruction of the lining. So anything that's a process, even nitrates, then certain countries, more smoked fish, for example, is popular smoked and cured meats, have been known to destroy the lining of the stomach or promote stomach cancer in large amounts.

But, those are

[00:22:20] Guest - Nina Nandy: Be aware of.

is really going to protect so many different, yeah that's really important. So given that you're from Texas, this means you never eat barbecue or anything like that, anything

barbecue person. I'm from the East Coast originally, but I've been in Texas for a couple years, but yes.

[00:22:42] Guest - Nina Nandy: I know I'm probably gonna get canceled by my, everyone in Texas by saying that our here is

Oh,

I understand that. And when you're on the East coast, you're not eating clam fried clam strips then or at least

not regularly.

right?

Moderation is key. I try to do plant-based when I'm at home, but when I travel, it's sort of, anything goes

Of course, there's some truth to it, but it's not the primary cause. So the primary cause, like I said, is usually H pylori bacteria or those drugs like NSAIDs. And so that's important to, get that sorted out. And then, the other sort of misconception is that ulcers are always painful.

No, that's not true. You can have other symptoms. There can be silent ulcers depending on where they are located. And then, there was this whole thing where avoiding spicy foods or eating a lot of dairy helps you feel better. Like, oh, have some yogurt or have some milk. Mm, you know, milk can also be, irritating to the gut lining, so that's not necessarily true. And, sometimes people say, ulcers are always treated by surgery, and that's not true either, because usually surgery is pretty rare to treat an ulcer unless it has, torn, perforated, or there's a horrible bleed that we can't control endoscopically. So those are like the biggest misconceptions I hear. My whole thing, if I could give listeners one piece of advice, if there's anything that's bothering you, please tell us. I rather know more than less. And there's something that's really on your mind, we'll let you know if it seems like, it doesn't make sense to treat for that.

But a lot of times, it's good to have peace of mind as well.

[00:24:54] Guest - Nina Nandy: Oh, yes, yes, yes. That's very important. So, , like I said, NSAIDs are non steroidal anti inflammatory drugs like Motrin, Aspirin, and Naproxen. They're the most common reasons, people, Generally take it for joint pain, arthritis or post surgery, migraine headaches, that sort of thing. So they're the most common because, they're over the counter.

And it does depend on how much and how frequently, or you're more at risk, obviously, if you're taking it every day for a long time. But there are other drugs, like, drugs for chemotherapy or steroids like prednisone that can irritate the gut lining, so, so we always want to make sure, someone's on long term prednisone has something to protect their gut. and certain things that we use for osteoporosis, like bisphosphonates can cause damage to the esophagus. So, always good thing to go over your med list and tell us if there's

[00:25:41] Guest - Nina Nandy: taking or yeah.

taking or

[00:25:52] Guest - Nina Nandy: Yeah, you know, for medications for, for sure. Yeah. So I always say, try to take the lowest therapeutic dose that gives you the desired effect. And and also, don't say take something if you don't need it. But you know, I have patients who are chronic arthritis and like the only thing that helps, for example, is naproxen. and if that's the case, and you can't take anything else tramadol or whatnot, Tylenol, if that doesn't help, then, Maybe you need to be on a medication to protect your gut lining while you're taking that medication. Maybe you need to be on some, H2 blocker, like a rinitidine, famotidine, that's like Zantac, Pepsi. Or you need to be on something like a Nexium. So, there are ways to either, change therapy to something else, or do something to lessen your risk.

[00:26:37] Guest - Nina Nandy: Find someone that you trust that is open to having this sort of discussion and communication with you. I really stress that the relationship between doctor and patient is very important. And if you feel like someone's not listening to you, or, you you're not getting what you what need to out of the conversation, it's okay to ask for another opinion or, sit down with uh, whoever, you feel is a good fit.

people and they have

Why are you telling them? Everything's great. You're having all these problems. We couldn't travel. You can't play golf. So I need to know.

[00:27:40] Guest - Nina Nandy: So, so I like

[00:27:41] Guest - Nina Nandy: a friend.

To your appointment. Dr. Dr. Nandy,

thank you so much.

There you go. That's okay. We're going to start. We will work with the AGA to to create a day like that.

So, all right. Dr. Nandy, thank you very much for everything and

all your insights on

[00:28:08] John Salak: Before we move on, we wanted to again encourage listeners to take advantage of the hundreds of exclusive discounts WellWell offers on a range of health and wellness products and services. These cover everything from fitness and athletic equipment to dietary supplements, personal care products, organic foods and beverages, and more.

Signing up is easy and free. Just visit us at WellWellUSA. com, go to Milton's Discounts in the top menu bar, and the sign up form will appear. Signing up will take just seconds, but the benefits can last for years. Okay, so by now it's clear that ulcers are serious business that can lead to serious consequences, which is why it is extremely important to speak to your doctor if you're having any related symptoms.

Of course, not all ulcers give off symptoms, so having periodic IG checks or scopes is also a smart move, especially for older or at risk individuals. There is good news in all of this, however. Diagnostics are improving all the time, making it easier to identify problems. What's more, the earlier a problem is identified, the easier and less invasive the treatment.

Early treatment also lessens the risk of other more severe complications from arising. Finally, a lot, if not most, treatments usually require just antibiotics or other medicines. Ultimately, the best advice we can give, don't overlook or dismiss ulcers. You'll wind up giving yourself one. Well, that's it for this episode of What the Health.

We'd like to thank Dr. Nina Nandy. with the AGA for her time and insights. If you'd like more information on the AGA's work, please visit gastro. org. That's gastro. org. That brings us to the end of this episode of What the Health. Thanks for listening in, and we hope you'll join us again.