Can This Gene Increase Your Risk of Peptic Ulcers? (CYP2C19)

Dietary Polyphenols

Multiple studies have found that certain dietary polyphenols conferred protection against peptic ulcers. Quercetin, a common flavonoid found in many fruits and vegetables, appears to protect the lining of the digestive tract by suppressing acid secretion and has been shown to inhibit CYP2C19 [R, R, R].

Some of the foods richest in quercetin include leafy green vegetables, red grapes, and berries.

Other polyphenols may protect the lining of the digestive tract by stimulating blood flow or preventing the release of histamine. Still others scavenge free radicals, inhibit oxidizing enzymes, and stimulate the body’s antioxidant defense mechanisms [R, R, R].

Food polyphenols proven to inhibit CYP2C19 include:

• Resveratrol (found in red wine, dark chocolate, berries, and peanuts) [R]
• Caffeic acid (found in sunflower seeds, apple sauce, apricots, prunes, and some herbs and spices) [R]
• Bergamottin (found in grapefruit juice) [R]
• Diosmetin (found in the peel of citrus fruits) [R]
• Naringenin (found in citrus fruits, tart cherries, tomatoes, dark chocolate, and beans) [R]
• Epigallocatechin gallate (found mainly in green tea) [R, R]

Garlic

Garlic is a hotly debated complementary approach for ulcers. In a recent meta-analysis, its active compound allicin improved healing rate and remission of the symptoms when used as an add-on therapy in case of H. pylori infection with ulcers [R].

However, the authors of this analysis noted that the evidence was still relatively weak and in need of further investigation.

This compound also inhibited overactive CYP2C19 variants, thus delaying the clearance of the proton pump inhibitor omeprazole, in a small trial on 18 people [R].

Garlic can be irritating on the stomach, so caution is advised if you already have ulcers.

Chilli Peppers

Some documents and guidelines advise against eating chili peppers if you have ulcers, but a surprising amount of research has suggested that capsaicin, the active ingredient in chili, could actually be beneficial [R, R, R].

Capsaicin inhibits the growth of H. pylori bacteria, which may explain why people given chili powder healed more quickly than their peers in a study of 50 ulcer patients [R].

This compound prevents stomach ulcers in animals, and may also help heal existing ones. It inhibits stomach acid secretions, reduces acidity, promotes mucus secretion, and stimulates blood flow in the stomach [R].

In a study in rats, capsaicin inhibited CYP2C19 and other enzymes from the same family [R].

We advise caution with capsaicin if you already have stomach ulcers, because it can also irritate the stomach.

Cruciferous Vegetables

Extracts from cruciferous vegetables such as kale and cabbage prevented the development of ulcers in different animal models by stimulating the production of mucus and lowering stomach acids [R, R, R].

Their active compound sulforaphane inhibited H. pylori  infections and activity in human, animal, and cell-based studies [R, R, R, R, R].

In H. pylori-infected type 2 diabetic patients, broccoli sprout powder, in addition to standard triple therapy, considerably improved H. pylori eradication. It also improved markers of heart health in these subjects [R].

Rats fed with kale showed a reduced activity of CYP2C19 and other proteins from the same family (measured as increased blood levels of drugs broken down by these enzymes), suggesting it may help people with the overactive variant [R].

Eating a diet rich in polyphenols and cruciferous vegetables helps prevent peptic ulcers and may reduce CYP2C19 activity. Garlic and chilli peppers may also help, but people with existing ulcers should be cautious due to their potential to irritate the stomach.

Stress Management

Most doctors and researchers agree that psychological stress and peptic ulcers are closely linked. In fact, a cohort study of 17,525 Danish adults found that people under high stress were more than twice as likely as people under low stress to develop ulcers [R, R].

Anxiety disorders, personality disorders, and panic disorders have also been directly linked to peptic ulcers. One study further found that alcohol or nicotine dependence exacerbated the connection between anxiety and ulcers; that is, people with anxiety disorders who were also dependent on alcohol or nicotine were even more likely to have ulcers [R, R].

A large body of research suggests that managing stress is very important for healing peptic ulcers. Some researchers have recommended the inclusion of cognitive behavioral therapies and other psychological strategies to help manage family, job, economic, and workload problems [R].

Studies in humans and mice have associated high CYP2C19 activity with anxiety and depression, possibly because it reduces the volume and function of a brain region involved in these disorders (the hippocampus). However, a recent human study couldn’t find this association [R, R, R, R].

People with overactive CYP2C19 variants may break down anti-anxiety and antidepressant drugs faster, potentially making the treatment less effective [R, R, R, R, R, R].

The close link between peptic ulcers and psychological stress has been studied extensively. CYP2C19 activity may also worsen anxiety disorders and interfere with their treatment.

Black Cumin

In a study of 88 patients with indigestion positive for H. pylori, black seed helped eradicate the bacteria and symptoms. A minimal dose of 2 g of the seeds (in combination with omeprazole) was effective and comparable to standard triple antibiotic therapy, while both lower and higher doses were less efficient [R].

Some studies suggest that it may also help protect the stomach lining from damage and ulcers, mostly based on findings from animal studies [R, R].

Black cumin seed protected the stomach lining from the harmful effects of alcohol in rats. The oils also prevented gut damage [R, R].

Its active compound thymoquinone showed moderate CYP2C19 inhibition in an enzymatic assay [R].

Ginger

Ginger increased protective prostaglandins in the stomach lining in 43 osteoarthritis patients who used NSAIDs long-term. Ginger could potentially be useful in people who developed ulcers from NSAIDs, but further clinical trials are needed [R].

In cellular studies, antioxidants in ginger (such as the flavonoids gallic and cinnamic acid) blocked the growth of stomach-ulcer-causing H. pylori, mainly by fighting free radicals [R, R].

Ginger extract reduced the drug-metabolizing activity of CYP2C19 in the lab [R].

Licorice Root

Licorice was a good adjunctive treatment to standard clarithromycin triple therapy in the treatment of H. pylori in a clinical trial on 120 people and increased the eradication rate by about 20% [R].

Licorice extract and its component licochalcone A inhibited CYP2C19 and other enzymes from the same family in the lab [R, R].

Preliminary research suggests that black seed oil, ginger, and licorice root may help with peptic ulcers mainly by helping eradicate H. pylori. Some of their components inhibited CYP2C19 activity.