Peptic Ulcer Disease: The Evidence-Based Supplement Protocol

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Peptic ulcer disease is treated with H. pylori eradication (where positive) and PPI therapy. NSAID-induced ulcers require NSAID withdrawal where possible. Several supplements have credible RCT evidence for accelerated healing or symptomatic improvement.

Zinc Carnosine (Polaprezinc), 75 mg Twice Daily

Zinc carnosine is the form of zinc with the strongest gastric mucosal evidence. Licensed in Japan since 1994 for gastric ulcer therapy. Multiple RCTs show accelerated ulcer healing comparable to ranitidine and as an effective H. pylori eradication adjunct. The compound has direct gastric mucosal binding and anti-inflammatory effects beyond what ionic zinc provides. See our zinc carnosine piece.

Deglycyrrhizinated Licorice (DGL), 380 mg Three Times Daily Before Meals

DGL has been used in peptic ulcer disease for decades with modest trial support. Small RCTs in the 1980s showed DGL produced healing rates comparable to cimetidine for duodenal ulcer. Glycyrrhizin removal eliminates the pseudoaldosteronism risk. See DGL piece.

Mastic Gum (Chios), 1 g Daily

Mastic gum has antimicrobial activity against H. pylori in vitro and small RCT evidence for symptom relief in functional dyspepsia and H. pylori-positive gastritis. Effect on actual H. pylori eradication is modest — not a substitute for triple/quadruple therapy. Reasonable adjunct.

Vitamin C — Adequacy

Adequate vitamin C intake is inversely associated with H. pylori colonization and gastric cancer risk in cohort data. Maintain ≥200 mg/day intake. Not a megadose intervention.

Probiotics for H. pylori Eradication Adjunct — Lactobacillus reuteri

Multiple meta-analyses show specific probiotic strains (Saccharomyces boulardii, L. rhamnosus GG, L. reuteri DSM 17938) added to triple therapy improve H. pylori eradication rates and reduce GI side effects of antibiotics. See S. boulardii piece.

What NOT to Take

Avoid whole licorice (glycyrrhizin-containing) — hypertension and hypokalemia with chronic use. Skip "stomach healing" megaformulas with subclinical doses. Avoid herbal "anti-H. pylori" cocktails as substitutes for evidence-based eradication therapy. Don't combine NAC with nitroglycerin without monitoring. Avoid NSAIDs entirely during ulcer healing — even occasional aspirin can perpetuate.

How to Run the Protocol

Test for H. pylori (urea breath test, stool antigen, or biopsy). Eradicate if positive with appropriate triple or quadruple therapy. PPI for 4–8 weeks for active ulcer. Layer zinc carnosine 75 mg twice daily + DGL 380 mg before meals + probiotic alongside eradication. Stop NSAIDs where possible. Re-test for H. pylori eradication at 4 weeks post-therapy. See condition page.