DEAR DR. DONOHUE: Will you please explain H. pylori? My doctor tells me I have it, but did not explain what it is, what brought it on or what to do or not to do about it. – D.L.

ANSWER: H. pylori, or Helicobacter (HE-lee-coe-BACK-tur) pylori (pie-LORE-ee), is a bacterium involved with stomach and duodenal ulcers and, in some cases, with stomach cancer. It’s one of only a few germs that can survive in the hostile, acid environment of the stomach. The H. pylori story is a bit complicated. In the United States it is found in 30 percent of all adults and in 50 percent of those older than 60. It increases the risk for coming down with an ulcer, and it’s responsible for the recurrence of ulcers.

If you look at those numbers, you realize something doesn’t add up. Thirty percent of all adults and 50 percent of those over 60 do not have ulcers. So, for most people H. pylori isn’t a troublemaker. They have the germ, but it’s not hurting them or causing any symptoms. Those people need no treatment. People who have an ulcer do need treatment with medicine that stops stomach acid production and with antibiotics to eradicate H. pylori. This combination all but assures a permanent ulcer cure. In the days before attacking H. pylori, ulcers tended to recur.

Who needs treatment? Those with an ulcer, those with a family history of stomach cancer and possibly a small number of those who suffer from dyspepsia. Dyspepsia is stomach pain, stomach burning and a feeling of fullness with only a few bites of food without an overt stomach problem detected. How the germ is acquired isn’t known.

DEAR DR. DONOHUE: What causes dropsy, or edema? Will the swelling go away? Is there any cure? – M.B.

ANSWER: Edema (“dropsy” is a word rarely used these days) is swelling of the feet, ankles and lower legs. It has many causes: heart failure, kidney disease, liver cirrhosis, low blood proteins, blockage of leg veins with clots, and some medicines, like the anti-inflammatory medicines Aleve, Motrin and Advil. The swelling comes from fluid that leaks out of blood vessels. The listed illnesses either cause too much fluid in the circulation or they obstruct the return of blood to the heart from the legs. Treatment depends on finding the cause. Sometimes gravity is the cause. Sitting in one position with the legs dangling downward draws fluid out of leg blood vessels, and the ankles swell.

The swelling responds to elevating the legs as often as possible and for as long as possible. Walking mobilizes fluid. Elastic stockings compress tissues and force fluid back into the circulation. The most important treatment is treatment of the cause.

The booklet on edema and lymphedema explains these two causes of swelling and their treatments. Readers can order a copy by writing: Dr. Donohue, No. 106, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address.

DEAR DR. DONOHUE: How effective is niacin in controlling cholesterol? What are its side effects? – M.J.

ANSWER: In small doses, niacin is a B vitamin. In large doses, it is a drug that can lower total cholesterol and LDL cholesterol, bad cholesterol. And it’s one of the few medicines that can raise good cholesterol, HDL cholesterol. It isn’t as potent as the statin drugs, but it appreciably lowers cholesterol.

Niacin can cause flushing. Taking an aspirin 30 to 60 minutes before taking niacin dampens the flushing reaction, and so does starting out with it in low doses. Niacin can also cause liver trouble, but it does so infrequently. It might disturb blood sugar control. Sustained-release niacin is less likely to cause flushing but slightly more likely to cause liver trouble. Niacin for cholesterol control should be considered a medicine, and it’s something better taken under a doctor’s supervision.

DEAR DR. DONOHUE: I am a vegetarian. After reading that vegetarians must be careful because the vegetarian diet lacks too many vitamins and the deficiency can cause leukemia, I am strongly thinking of going back to my old diet. How true is this? Do I risk coming down with leukemia? – M.D.

ANSWER: Much of the world’s population exists on a vegetarian diet. It’s a diet that has proven health benefits. It decreases the chance of heart disease, stroke and diabetes. It’s been shown to prolong life.

A strict vegetarian diet, one that eschews dairy products, can be low in calcium, and people on such a diet have to make an effort to get the recommended amount. Iron in plant food is less well absorbed than iron in meat, so iron deficiency is a theoretical problem, but it rarely happens. Being deficient in vitamin B-12 is a problem. It is found only in meat. But the lack of B-12 in plant food can be overcome by eating foods fortified with the vitamin. Many cereals, for example, contain it. Fortified soy milk is another source for it. I cannot find any substantiation for the leukemia risk. I say stick with your diet. It’s a healthy one.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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