7 Supplements That May Help Treat Peptic Ulcers and 3 To Avoid

Answer:

Peptic ulcers are sores in the lining of the stomach (i.e., "gastric ulcers") or the small intestine (i.e., "duodenal ulcers"). In some people, peptic ulcers cause no symptoms. In other people, ulcers may cause pain in the upper part of the belly, bloating, and nausea. In people with severe ulcers, bleeding can occur.

Peptic ulcers are caused by long-term irritation. The most common causes of irritation include Helicobacter pylori (H. pylori) infection or regular use of nonsteroidal anti-inflammatory drugs (NSAIDs). Peptic ulcers caused by H. pylori infection are treated with antibiotics. Peptic ulcers caused by NSAIDs require stopping use of NSAIDs when possible. Acid reducers such as proton-pump inhibitors can be used to ease irritation of ulcer until it heals.

Certain supplements have been used alone or along with antibiotic therapy for H. pylori infection, and some, but not all, have shown benefit in eliminating H. pylori from the gut or decreasing side effects of antibiotic treatment. On the other hand, some supplements may worsen symptoms of peptic ulcer disease and should be avoided by people with this condition.

Supplements that may reduce symptoms of peptic ulcers

Berberine

Berberine is from goldenseal root. Some research has shown that taking berberine with triple therapy for H. pylori (i.e., clarithromycin, amoxicillin, and esomeprazole) can modestly increase eradication rate while reducing side effects of triple therapy alone (Jiang, Evid Based Complement Alternat Med 2018). Other research has shown that the combination of berberine along with triple therapy eradicates H. pylori about as effectively as triple therapy plus bismuth (Zhang, Medicine 2017). Berberine is generally well-tolerated at the doses used in clinical studies (about 900 mg to 1,500 mg per day), although it may cause gastrointestinal symptoms in some people and should be used cautiously or avoided with certain medicines, such as those that lower blood sugar, those that lower blood pressure and those broken down by certain liver enzymes. For more details, see the Concerns and Cautions section of our Berberine and Goldenseal Supplements Review, which includes our Top Pick for berberine.

Cranberry

Cranberry, commonly taken to help prevent urinary tract infections, has shown modest benefit for reducing H. pylori infection when used alone or along with antibiotics, although the greatest benefit seems to occur when used with antibiotics. Research has shown good evidence for cranberry juice when taken in dosages of 250 mL (about 8 oz) twice daily along with antibiotics for H. pylori, although some research has found that only cranberry juice with high amounts of proanthocyanidins (about 44 mg per 8 oz serving) is beneficial (Zhang, Helicobacter 2005; Shmuely, Mol Nutr Food Res 2007; Li, J Gastroenterol Hepatol 2020). The effects of cranberry supplements have also been positive, but details regarding the form and concentration of proanthocyanidins in the cranberry supplement used were not specified (Seyyedmajidi, J Res Pharm Pract 2016).

Cranberry is generally well-tolerated, although it may cause gastrointestinal upset or skin redness and itching in some people (McMurdo, Age and Ageing 2005; Wang, Arch Int Med 2012). Cranberry juice might not be appropriate for people with diabetes, those at risk for kidney stones, or those with an allergy to aspirin. See our Top Picks for cranberry juice and supplements.

Lactoferrin

Lactoferrin is a naturally-occurring, iron-binding protein in mammalian milk. In supplements, lactoferrin is often promoted for "supporting" the immune system and improving gut health. One study suggests that taking lactoferrin may help suppress, but not eradicate, H. pylori infection. Lactoferrin appears to be well-tolerated by most people, but it may trigger allergic reactions in people with milk allergies (Hochwallner, Methods 2014).

Licorice

Taking 380 mg of licorice extract containing less than 3% glycyrrhizinic acid twice daily along with standard antibiotic therapy for 2 weeks has been shown to moderately improve H. pylori eradication, particularly in people with peptic ulcer disease, when compared with antibiotics alone (Hajiaghamohammadi, Braz J Infect Dis 2016). Small amounts of licorice may be safe for most adults to use short-term but regular use of non-deglycyrrhizinated licorice can cause a loss of potassium, which can have serious health consequences.

Melatonin

Blood levels of melatonin have been found to be lower among people with H. pylori infection who are experiencing pain. Animal studies suggest that melatonin may help protect the stomach lining and aid ulcer healing. One study showed that taking 5 mg of melatonin twice daily along with triple therapy (i.e., metronidazole, amoxicillin and omeprazole) for 2 weeks helped heal ulcers in more people than triple therapy alone (Celinski, J Physiol Pharmacol 2011). However, the triple therapy used in this study is not the regimen used in the U.S. Short-term use of melatonin supplements appears to be generally safe for adults, although it can interact with certain foods and medications. For more information about possible side effects or interactions, see the Concerns and Cautions section of our Melatonin Supplement Review, which includes our Top Picks for melatonin.

Oregano oil

Oregano oil has demonstrated antibacterial activity against clinical strains of H. pylori in laboratory studies (Korona-Glowniak, Molecules 2020). However, it is uncertain if oregano oil is beneficial in humans. A clinical study among 39 people positive for H. pylori infection (based on stool sample testing) and with symptoms of infection (e.g., heartburn, gas, irritable bowel symptoms, etc.) or a history of peptic ulcer disease found that taking a "cocktail" of non-prescription ingredients to include a 50-mg tablet of emulsified oregano oil three times daily for two weeks eliminated H. pylori in 74.3% (29 out of 39) of participants, all of whom reported improvements in their symptoms. However, this study lacked a placebo group, which is needed to prove a benefit. Furthermore, other ingredients in the supplement cocktail included mastic gum, Pepto-Bismol, a probiotic (Vital 10 by Claire Laboratories) and a fiber supplement (Herbulk by Metagenics). Therefore, the specific effect of oregano oil is uncertain (Liponis, Nat Med J 2015).

Probiotics

Probiotics are viable (live) bacteria and/or yeasts that confer a health benefit. Although some evidence suggests that taking probiotics containing Lactobacillus, Bifidobacterium or Saccharomyces species in addition to antibiotics may help to increase eradication of H. pylori (a causative agent of stomach ulcers), most of the studies examining probiotics for H. pylori infection have been conducted in China and are not well designed. Furthermore, questions remain as to which probiotic strain may be most beneficial and what dose and duration of treatment would be optimal for improving eradication. For this reason, the American College of Gastroenterology does not recommend for or against the use of probiotics with antibiotics to treat H. pylori infection.

Nonetheless, if you will be taking antibiotics to treat H. pylori infection, many studies have shown benefit of probiotics for reducing the risk of diarrhea associated with antibiotic treatment. To find out which probiotics have evidence of decreasing this side effect of antibiotics, see our Top Picks for probiotics in our Probiotic Supplement Review.

Products unlikely to help with peptic ulcer disease

Manuka honey

Manuka honey has been promoted for the treatment of gastric/stomach ulcers caused by H. pylori. However, a very small study found that taking manuka honey for two weeks did not eliminate H. pylori infection in affected people (McGovern, J R Soc Med 1999).

Mastic gum

Mastic gum is made from the resin of a mastic tree. Research conducted in the 1980s evaluating mastic gum for peptic ulcer disease suggested that it had modest benefit for healing peptic ulcers (Al-Habbal, Clin Exp Pharmacol Physiol 1984). However, more recent studies have shown that taking mastic gum does not help eradicate H. pylori, indicating that it probably has no benefit for treating the most common cause of peptic ulcers (Bebb, J Antimicrob Chemother 2003; Dabos, Phytomedicine 2010).

Supplements that may possibly worsen symptoms of peptic ulcer disease

Arginine

It has been suggested (but not proven) that high dose oral arginine may increase stomach acid levels and worsen esophageal reflux (heartburn). For this reason, individuals with ulcers or esophageal reflux, as well as those taking NSAIDs that can be hard on the stomach, should use caution when taking arginine.

Feverfew

Feverfew, which is common taken for headache relief, might worsen peptic ulcers. Feverfew seems to reduce the production of prostaglandins (Collier, Lancet 1980). Prostaglandins have shown some benefit in preventing and/or treating peptic ulcers (Wilson, Postgrad Med 1987). Taking feverfew, especially in combination with NSAIDs, might increase the risk of stomach problems including peptic ulcers.

Iron

Occasionally, use of iron pills can damage the protective lining of the stomach, leading to stomach erosions and ulcers, and gastrointestinal bleeding (known as iron-pill induced gastropathy). This may be more likely to occur in older adults. The liquid form of oral iron is less likely to damage the lining of the stomach. Gastritis and a non-bleeding stomach ulcer have also been reported in a person taking iron pills for iron-deficiency anemia.

Many other supplements may also cause stomach irritation and heartburn. People with or at risk for peptic ulcer disease may want to avoid these supplements. To find out more, see our Answer to Supplements That Can Cause or Worsen Acid Reflux & GERD.

Bottom Line

For patients with peptic ulcers due to H. pylori infection, taking probiotic products containing Lactobacillus, Bifidobacterium or Saccharomyces boulardii strains or drinking cranberry juice may be beneficial when used along with standard antibiotics. It is uncertain if taking melatonin is beneficial when used with first-line antibiotic therapy for H. pylori infection. Lactoferrin may help suppress but does not seem beneficial for eradicating H. pylori. Berberine, licorice and oregano oil may also be beneficial, but research is still preliminary. Taking mastic gum or honey does not appear to be beneficial. Supplements such as arginine, feverfew, and iron should be used cautiously, as these may worsen symptoms of peptic ulcer disease.