Stomach complaints number among the most frequent in our society and can be debilitating. Unfortunately for the unaware public, the diagnosis given and the treatments of choice are often exactly the wrong ones. The GI system is a “Top-Down” one, in that a problem at the beginning will lead to problems further down.
The most common stomach ailments include familiar sounding names such as: acid reflux (Gastro-esophageal reflux or GERD), “over-acid” stomach, ulcer and gastritis. Here is a quick true or false quiz to check your knowledge of common stomach ailments: 1) Most stomach and esophageal complaints are a result of too much stomach acid- T/F 2) The best treatments for these complaints are medications like Prilosec that decrease stomach acid- T/F 3) Most ulcers are caused by stress- T/F. Almost everything you have learned about these complaints from your friendly pharmaceutical ads on TV is incorrect. If you answered true to any of the questions you are dead wrong
Let’s begin with an “over-acid” stomach that is supposed to be the cause of ulcers and GERD. The stomach is the main location of protein digestion, which must occur in an acidic environment. One of the truly amazing feats of the body, one that is little appreciated, is that, to go from the average body pH of about 7.2 to the harsh acidic environment of the stomach, pH 1-2.5, requires that the body concentrate hydrogen ions (acid) over 3,000,000 times that of the blood! To create a liter of stomach acid requires 1,500 calories!
Chronic stomach ailments become more frequent the older we get. Now ask yourself- given that it takes a huge effort by the body, one that requires many calories and the presence of many essential nutrients to create stomach acid (HCL) and given that as we age virtually all metabolic processes slow down, does it really make sense that most stomach complaints are due to too much acid? No, it makes sense that they are due to too little acid (hypochlorhydria). If you have stomach complaints, please take the test below and score your results. Simply click the answer, 0,1,2,or 3 that most closely represents the correct answer to the question for you. To total the score, click “Compute Score” below the test.
All of the questions above are signs and symptoms of hypochlorhydria. If you scored 10 or higher or if you are taking any stomach medications, you probably have low stomach acid. If you feel fuller sooner, stay fuller longer than you used to or if you burp within 30-60 minutes of eating, you probably have low stomach acid.
What does stomach acid do? It sterilizes food, killing pathogenic bacteria; it digests protein itself and also activates the protein digestive enzyme pepsin. Without HCL, the inactive pepsinogen produced by the stomach is not converted to active pepsin. HCL signals the lower esophageal sphincter to close! When LOW stomach acid decreases the ability of the sphincter to close the acid that is produced can reflux back into the esophagus causing GERD!! Finally, stomach acid is one factor stimulating the release of Secretin from the pancreas, which then causes release of pancreatic digestive enzymes and bicarbonate to continue the digestion process. This in turn also inhibits more food from being dumped into the small intestine before it is adequately digested in the stomach.
Some of the important factors that can affect the ability to produce HCL are: low levels of certain amino acids, lack of zinc and potassium; a diet high in refined carbohydrates and fat; sodas; poor nutrition leading to mitochondrial dysfunction (mitochondria produce the energy needed to concentrate acid); use of antacids and proton pump inhibitors and infection with the bacteria H. pylori.
So what actually causes GERD? It probably starts with low stomach acid, which then causes the esophageal sphincter to not close tightly, leading to what acid there is refluxing into the esophagus, causing inflammation and ulceration of the sensitive esophageal mucosa. At the same time, low acid may cause intestinal dysbiosis, or overgrowth of undesirable bacteria. These bacteria then ferment sugars from a bad diet. High levels of hydrogen or methane gasses produced by bacterial fermentation have also been shown to decrease esophageal sphincter closing- a double whammy!
Standard treatment options are exactly the wrong ones. There are multiple medications to neutralize or block production of HCL. Unfortunately low acid is what started the problem in the first place. Yes, the treatments do offer that ever-so-valuable “temporary relief from heartburn”, but in the long-run exacerbate and perpetuate the problem. If you have been prescribed Prevacid or similar medication for a protracted period of time, you are at risk for increased rates of osteoporosis and stomach cancer. Has your MD actually checked your levels of production of HCL, checked for an H.pylori infection or done an endoscope? Have you continued with the same complaints, trying different medications with no resolution? Have your digestion and GI complaints become progressively worse? You might want to re-think your treatment options.