MALAYSIANS are born with a cili padi in one hand and a plate of nasi lemak sambal in the other.
From the fiery curries of the mamak stall to the spicy laksa that makes grown adults weep with joy, spice is not just a seasoning here. It is a way of life.
Yet for generations, well-meaning relatives have warned that all this heat would eventually burn a hole in the stomach.
Is the beloved cili padi really out to destroy Malaysian digestive systems from the inside?
Verdict:
FALSE
Not only does spicy food not cause gastric ulcers, there is growing evidence that capsaicin, the active compound that makes chillies hot, may actually help protect the stomach lining.
First, some background. A peptic ulcer is an open sore that forms when the protective mucous lining of the stomach or upper small intestine breaks down, allowing stomach acid to erode the tissue beneath.
For most of the 20th century, doctors believed that spicy food, stress and excess stomach acid were the primary culprits. Patients were put on bland diets and told to avoid their favourite foods.
That all changed in the 1980s, when Australian researchers Barry Marshall and Robin Warren discovered that most peptic ulcers were actually caused by a bacterium called Helicobacter pylori.
The pair went on to win the Nobel Prize in Physiology or Medicine in 2005 for the discovery, which completely overturned decades of medical thinking.
A review published in PubMed titled Capsaicin and Gastric Ulcers confirmed the paradigm shift plainly, stating that chilli and its active principle capsaicin was not the cause of ulcer formation but a benefactor.
The same review noted something particularly interesting for Malaysians: an epidemiological survey in Singapore found that gastric ulcers were three times more common among Chinese patients than among Malaysians and Indians, the very groups most likely to consume larger quantities of chilli on a daily basis.
A peer-reviewed pharmacology review published in ScienceDirect, examining capsaicin's role in gastrointestinal health, found that capsaicin significantly enhanced the repair and healing of gastric mucosal damage and helped prevent injury caused by ethanol and aspirin, two substances that genuinely do damage the stomach lining.
The same review found that in vitro studies showed capsaicin exhibited anti-H. pylori activity, meaning it may actually help fight the very bacterium responsible for causing most ulcers in the first place.
Research published in the Journal of Gastroenterology and Hepatology, examining decades of H. pylori epidemiology data from the University of Malaya, found that H. pylori infection had declined significantly in Malaysia over a 20-year period and that peptic ulcer disease had dropped to low levels across all groups.
A peer-reviewed study published in the Malaysian Medical Journal, examining 400 consecutive gastric biopsies in north-eastern peninsular Malaysia, found an overall H. pylori prevalence of just 13.5%, with the rate among Malay patients as low as 6.6%, figures described by researchers as unusually low by global standards.
So if not the cili padi, what actually causes ulcers?
According to the Malaysian Medical Gazette, the two primary causes of peptic ulcers are H. pylori infection and the long-term use of nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen and aspirin. In Malaysia, the prevalence of duodenal ulcers stands at 9.5% and gastric ulcers at 9.4%.
Smoking, excessive alcohol consumption and prolonged psychological stress were also identified as contributing factors by the American College of Gastroenterology, though their role was as risk factors rather than direct causes.
Spicy food can, however, aggravate symptoms in people who already have an existing ulcer or who suffer from conditions such as irritable bowel syndrome or dyspepsia.
The National Health Service in the United Kingdom advises people with active ulcers to avoid spicy foods while healing, not because spice caused the problem but because it can make an existing one harder to manage.
So the next time a relative slides the sambal away and says it will give someone an ulcer, feel free to politely disagree, armed with a Nobel Prize-winning discovery and several decades of peer-reviewed research. The cili padi did not do it. More likely, it was the ibuprofen they took for that headache last week.
Sources:
1. https://pubmed.ncbi.nlm.nih.
2. https://pubmed.ncbi.nlm.nih.
3. https://pubmed.ncbi.nlm.nih.
4. https://www.sciencedirect.com/
5. https://onlinelibrary.wiley.
6. https://academic.oup.com/
7. https://www.mmgazette.com/
