There was no early warning, not even a twinge. One minute, I was boarding a train last October.
The next, I felt very peculiar — clammy, dizzy, weak, almost unable to stand up. I had never felt like this before.
I had no temperature so I simply assumed that it must be a reaction to the Covid booster jab I’d had a few days earlier.
The next morning, I felt even worse. A day later — still with no temperature and several negative Covid tests — I collapsed in the bathroom, breaking a towel rail. I could barely crawl back to bed.
My wife, Diana, insisted that I call our local surgery. After a few questions, the doctor offered to call me an ambulance to get me to A&E: I was exhibiting classic signs of internal bleeding and needed to be seen fast.
There was no early warning, not even a twinge. One minute, I was boarding a train last October. The next, I felt very peculiar — clammy, dizzy, weak, almost unable to stand up. I had never felt like this before, writes Robert Hardman (pictured)
I summoned a minicab instead. By the time I got to London’s Charing Cross Hospital, I was collapsing again.
The A&E team soon established the problem. Blood had been leaking into my digestive system and, as a result, my haemoglobin — the protein that contains iron and transports oxygen — was at half the requisite level.
An emergency endoscopy (a camera in a tube which goes down the throat to the stomach) revealed the cause: two gastric ulcers. Two blood transfusions and a series of drips halted the rot while the doctors decided what to do next.
This had been a lucky escape. Left to my own devices, I would have slept my way through this feverless ‘flu’ and, in the process, might well have bled to death.
Thanks to my wife, my GP, A&E and a dietary epiphany, I was going to be fine — eventually. But it would take six months and something akin to a lifestyle transplant on the shores of an Austrian lake.
So how had I managed to contract two ulcers without even noticing? How was I going to ensure that it didn’t happen again? And why, even after my discharge from hospital a couple of days later, did I feel sick with fatigue walking up a few stairs?
In years gone by, stomach ulcers were much more common and often down to a bacteria called helicobacter pylori, a known cause of stomach cancer.
Just in case I had this bug, I was immediately put on two courses of antibiotics. As for patching up the two holes in the lining of my stomach, this would be left to a daily dose of omeprazole, the tried-and-tested ulcer treatment that stops acid production.
Thanks to my wife, my GP, A&E and a dietary epiphany, I was going to be fine — eventually. But it would take six months and something akin to a lifestyle transplant on the shores of an Austrian lake
Tests soon showed I did not have helicobacter pylori. It did not take the doctors long to work out the root cause of the ulcers: aspirin.
Seven years earlier, I had read somewhere that an aspirin a day significantly reduces the chance of having a heart attack.
So I’d been taking a normal 75g tablet every night ever since, with no discernible side-effects. It had simply become one of those bedtime routines, much like teeth-cleaning.
Sadly, I must have missed the articles warning of the flipside, namely that a daily aspirin can also corrode the lining of the stomach, leading to ulcers.
I may have mentioned the aspirin in passing to a doctor (being on statins, I have an occasional review of my prescription). But, if I did, I don’t ever recall being warned off. In other words, it seemed of no importance.
Jeremy Sanderson, who is a professor of gastroenterology at Guy’s and St Thomas’ NHS Foundation Trust in London, is well-used to patients in my predicament.
Any consumption of aspirin, he points out, will lead towards some sort of gastric ‘erosion’ — and, generally, any such erosion more than 5mm in size is called an ulcer. When they breach a blood vessel, as mine did, then the bleeding begins.
In years gone by, ulcers were often attributed to high stress levels. Then helicobacter pylori proved the more likely cause. But improving sanitisation levels mean the prevalence of this bacteria has declined in Western populations so, nowadays, most ulcers are linked to drugs such as aspirin and ibuprofen. (Aspirin blocks the enzymes that produce prostaglandins, which protect the stomach lining.)
As Professor Sanderson explains, this allows gastric acid and pepsin — the enzyme which breaks down protein in food — to ‘auto-digest the stomach lining, causing ulcers’.
I haven’t touched an aspirin since my lucky escape. A follow-up endoscopy just before Christmas showed that one of the ulcers had almost healed and the other was on the mend.
Another probe down the gullet two months later showed that my innards were almost back to normal.
So why did I still feel so feeble?
My haemoglobin, and, therefore, my iron levels, were still well below normal. For a man, the former should be either side of 15g/dL and I was still at 10.
Professor Sanderson says it can take months to rebuild haemoglobin levels, aided by a course of iron supplements: ‘What the body needs is time and iron.’
My body needed something else, too: a reboot. Years before, Diana had spent a week at Austria’s Original FX Mayr clinic, which was established on the principles of the early 20th-century intestinal guru Franz Xaver Mayr. His belief was that the gut is the body’s second brain, and that by re-setting a healthy gut you get a better body.
Diana and I had often talked about paying a visit together one day. It proved to be a godsend. This is essentially a luxury hotel with a lot of treatment rooms, no bar and an all-pervading sense of deep relaxation. A team of 80 staff (double the number of guests during our stay) deploy nothing stiffer than well-argued persuasion to keep you focused on ‘the cure’.
This means a caffeine-free, booze-free diet of 450 calories a day (plus Epsom salts) spread across breakfast and lunch with nothing in between except an inconsequential bowl of clear broth for ‘dinner’.
Meals must be conducted in silence to encourage extended chewing of every mouthful (phones and screens are banned).
In between, guests try a range of treatments, from osteopathy and shiatsu, to acupuncture, cryotherapy (three minutes dancing on the spot in a glass box in your undies at minus-110 degrees) and ‘altitude training’ (lying in a reclining chair and absorbing fluctuating quantities of oxygen to boost metabolic rates).
Every guest is tested on arrival (including a 3D body scan) to establish their ‘cure’ programme: I was in need of iron — plus vitamins B and D — and received a series of ‘infusions’ by drip. There is also exercise on offer. I didn’t feel much like it to start with but, eventually, embraced aquatic aerobics and even plunged into the lake.
There are also lectures on how to adjust back in the real world — with advice to skip an evening meal twice a week, relentless chewing and no late-night TV.
My concern, in advance, was how I would last from lunchtime to the following breakfast without any semblance of a real meal. But after a day, I wasn’t really hungry.
I looked forward to breakfast (a pot of sheep’s yoghurt, a buckwheat roll and a choice of light vegetarian ‘spreads’) and lunch (soup and another roll and spread).
The food is beautifully prepared; there just isn’t very much of it. But you soon learn that a little goes a long way.
Beforehand, I had visions of leaving the Mayr and promptly stuffing my face at the airport cafe. After ten days there, though, I more or less stuck with the programme for another ten days, as advised.
I had lost 7lb and more than 3 per cent of my body fat. Of far greater importance was that I felt brilliant. I could jog up the stairs, and my all-important haemoglobin level was back up to 12 g/dL and rising.
The Mayr ‘cure’ comes at a price, comparable to many a skiing trip. A week starts at £1,500, plus accommodation (starting at £160 per person per night for two sharing).
But to come home feeling immeasurably stronger was not just bewildering. Six months after collapsing on the doorstep of A&E, it felt nothing short of miraculous.
Robert Hardman received complimentary treatment from FX Mayr (original-mayr.com).
DR MARTIN SCURR: You can take it safely, but talk to your doctor first
One of my patients, who’d been to see me weekly for more than a month since undergoing weight-loss surgery, called me to say he was bedridden with severe food poisoning.
I went to see him at home within the hour and was alarmed to see how ill he was: sweating, his blood pressure was so low I couldn’t get a reading, and his pulse, which should have been 60 to 100 beats per minute, was 120.
It only took me a moment to realise that the diarrhoea he had also started passing — black as tar — was melaena, a sign of bleeding in the intestine.
I asked him about his medication and he told me that he decided to take a dose of aspirin, one tablet of 75 mg each day, as it seemed to him that this was a good idea for someone overweight, with high blood pressure and raised cholesterol levels. He was sorting out his obesity — he had undergone the operation — but was now worried about his heart.
Aspirin, even small doses, has the potential to cause a torrential haemorrhage from the lining of the stomach after only one or two doses. This is also a potential risk with other non-steroid anti-inflammatory drugs such as indomethacin and ibuprofen. That’s why when these are prescribed, patients are always warned about the risk of gastric side-effects: commonly indigestion but sometimes worse.
A small daily dose of aspirin is often prescribed to patients with heart disease or following a stroke in order to prevent dangerous blood clots. But the difference is that such patients are usually warned to watch for signs of this danger, such as indigestion-type pain and black-coloured stools (seek immediate advice for either).
I asked him about his medication and he told me that he decided to take a dose of aspirin, one tablet of 75 mg each day, as it seemed to him that this was a good idea for someone overweight, with high blood pressure and raised cholesterol levels [File photo]
Furthermore, people on aspirin tend to be on other medication such as statins and, as a result, will have regular monitoring. This will include blood tests which will pick up any bleeding, as bleeding is not inevitably torrential — it can be drip by drip, over time leading to anaemia (where there is a drop in haemoglobin).
My patient, who was just 47, died following his emergency admission. He was in the operating theatre within an hour of arrival and required more than 20 units of blood for resuscitation, but sadly did not survive.
This is a warning to us to be respectful about all medications that can upset the stomach lining, particularly the humble aspirin.
It is distressing to realise that this man died by his own good intentions, self-treating with a readily available drug which he believed would work in his best interests. I would argue that even if the prescription had been initiated by myself, the same complication could well have occurred, such is the nature of this unpredictable side-effect.
If your doctor is prescribing aspirin, my advice would be to request an occasional blood test to check for anaemia and discuss whether a regular acid suppressant drug such as omeprazole might also be a good idea — for protection — even though the jury is still out on that one.
Why frozen spinach can be better for you than fresh
How you serve this green vegetable affects its health-giving properties in surprising ways.
Fresh spinach is a rich source of vitamin K which promotes bone health, as well as calcium, vitamin D, fibre, potassium (a 90g serving contains more potassium than a banana), magnesium and vitamin C. It also provides beta carotene, zeaxanthin, lutein and chlorophyll, needed for good eyesight and immunity.
Lutein levels are higher in raw spinach, followed by frozen and canned, according to a 2008 study by University College Cork — but the nutrients are depleted if spinach is left to languish on a supermarket shelf or in your fridge.
A study in the Journal of Food Science found that spinach in a fridge loses its folate and carotenoid content at a slower rate than when left out of the fridge. After eight days, much of its nutrients will be lost.
But you need to add fat to your spinach salad or smoothie to absorb its fat-soluble vitamins A, D, E and K.
A study in the American Journal of Clinical Nutrition found that using a fat-free dressing on raw leaf salads significantly reduced absorption of vitamins A and K compared with a full-fat dressing or adding slices of avocado.
Spinach is a good source of iron, but dress your spinach salad with lemon juice. The vitamin C in the juice increases the uptake of iron by up to three times, according to a study in the American Journal of Clinical Nutrition.
Dr Sarah Schenker, a dietitian based in London, warns against over-consuming fresh spinach by stuffing handfuls into a ‘green’ smoothie.
‘Blending spinach allows you to consume greater quantities than you might in a salad, but this could lead to a build-up of chemical oxalate, which can cause kidney stones and which also blocks the absorption of other nutrients,’ she says.
Opt for baby leaves. Research has shown that these have more polyphenols (health-giving plant compounds).
In a 2017 study, Stephen Fry, a professor of plant biochemistry at Edinburgh University, found that the vitamin C content was higher in baby spinach, and that it seemed to be better able to hang on to nutrients.
Don’t wash leaves too vigorously, either. Professor Fry said: ‘Our experiments showed that the mechanical stress experienced by spinach leaves during washing led to a significant loss of ascorbate [vitamin C], whereas mere submersion did not affect the ascorbate content.’
As frozen vegetables are picked when nutrient levels are at their highest and frozen rapidly, nutrients which might be lost as it sits in the supermarket tend to be preserved for longer.
A study in the journal Food Chemistry found that fresh spinach loses 75 per cent of its vitamin C within seven days of harvest. But the blanching process (where spinach is dipped in boiling water to destroy bacteria before it is frozen) means frozen spinach loses 61 per cent of its vitamin C. Reduce further losses by cooking it unthawed.
Cooking spinach reduces its volume to less than 10 per cent. Size for size, one portion of cooked frozen or canned spinach has roughly four times the amount of fibre, folate, iron and calcium as a portion of raw, says Dr Schenker.
Plant foods such as spinach also provide ‘non-haem iron’, which the body can struggle to absorb efficiently, as the oxalic acid in fresh spinach binds with the iron, blocking its absorption.
But boiling spinach reduces oxalates by up to 87 per cent, according to a 2011 study in the International Journal of Food Properties.