Hot shots part Deux

Reader Biomed Tim questioned the article I wrote detailing the case of a man who got more than a dozen ulcers after going on a hot-pepper regime in an attempt to lose weight. His doctors maintained that the chili diet gave him the ulcers and that they cleared up soon after he was told to lay off the hot stuff. Tim disagreed with the diagnosis in the comments to this post:

Hmm...unlike you, I do NOT trust the doctor's judgment on this one...'cuz it's BAD SCIENCE. [snip]

There is no evidence that hot-pepper diet can lead to weight loss by itself, but NOR is there any evidence that the diet causes ulcers, as the Taipei Times article seems to suggest. (in fact, ulcers are often caused by bacterial infection)

After doing some web searching, it seems that WebMD and some other sites have Tim's back.

So to get to the bottom of this, I decided to get some second opinions...so docs, can eating hot peppers lead to ulcers?

(Doc 1: Chief gastroenterologist, Taipei area medical center): It's possible. It's not a leading cause like Helicobacter Pylori, but I have seen it in some individuals. (When asked why no study supports this) When you're practicing you come across a lot of individual cases who are not explained by large-scale studies.

(Doc 2: Chief gastroenterologist, Taipei area medical clinic): Hot peppers are among a wide number of irritants that can lead to ulcers in some individuals. Not everybody is sensitive to it just as nobody is sensitive to aspirin. If the timeline is as the doctor in your story summerized, I would believe him. (When asked why no study supports this) Individuals vary very widely when it comes to sensitivity. I have seen a patient so sensitive to aspirin he developed ulcers after one isolated dose.

(Doc 3: Gastroenterologist, Taipei area big-ass hospital. OK I'll say it. It's Taida.): Seventy percent of ulcers are caused by H. Pylori and the rest are caused by a variety of factors. Usually with H. Pylori, you get one or two ulcers. It is more common to find more smaller ulcers where irritants is the cause. (When asked whether the Dr. Hsiao is warrented in saying that the chili diet caused the man's ulcers)However, there is no literature whatsoever supporting the contention that chiles cause ulcers. If the heat of the peppers caused the ulcers, why no ulceration in the mouth? Why don't people in Sechuan have more ulcers? (So is Dr. Hsiao wrong?) I don't know. But his word is not evidence. How do we know that there were not some contributing factors that coincided with the chili consumption? It is true that many doctors encounter what look like cases of ulcers caused by hot-peppers in their practise. But can we say for sure that that it is truly a cause? Not without scientific studies. (Would you ever advise an ulcer patient to lay off the pepper?)Only after I have ruled out H. Pylori, painkillers, smoking and stress.

And finally I got through to Dr. Hsiao again. He confirmed that the patient was not taking painkillers and had no H. Pylori infection and reiterated his belief that chili, though not a major cause, do indeed irritate the stomach lining enough to cause ulcers in a small minority. "I myself cannot tolerate a spoonful without painful irritation," he said.

So, do hot pepper cause ulcers in a small minority of the population? I guess it depends who you ask. But unless you're pooping black stools and can find no other reason why you might have ulcers, keep eating it.