Stomach Disorders:

Americans now spend approximately $3 billion a year on over-the-counter heartburn drugs, according to the American Pharmacists Association. But there's a lesser known, frequently overlooked condition called hypochlorhydria, when the stomach doesn't produce enough acid.

What Are The Signs And Symptoms Of Hypochlorhydria?

People with hypochlorhydria often say that they feel hungry all the time. Food isn't being properly digested, and absorption of nutrients is impaired, triggering hunger.

How Common Is Hypochlorhydria?

More common than you might think. it's estimated that 50% of the population have hypochlohydria.

Stomach acid production naturally declines with age beginning in the mid thirties. By the time people reach their fifties, some doctors who treat this condition say that the percentage of people with this condition is closer to 50%.

While it's undisputed that production of stomach acid slows with age, most conventional doctors don't test for or know how to treat this condition.

Why Is Stomach Acid Important?

Stomach acid plays a vital role in maintaining good health. Let's take a look at some of the functions these gastric juices have:

The stomach glands that produce acid also produce intrinsic factor, a substance needed to absorb vitamin B12. Symptoms of vitamin B12 deficiency are depression, fatigue.

What Causes Hypochlorhydria?

Related Conditions

Because food isn't being properly digested and nutrients aren't absorbed, hypochlohydria is believed to contribute to the onset of many diseases, including:

How Is Hypochlorhydria Diagnosed?

If you think you may have hypochlorhydria, it's important to receive a proper diagnosis, because hypochlorhydria can be confused with hyperacidity and gastric ulcers, conditions at the opposite end of the spectrum.

The Heidelberg Gastric Analysis Test www.phcapsule.com is considered one of the most accurate. it's also one of the most expensive tests. The Heidelberg test involves swallowing a vitamin-sized capsule containing a pH meter and radio transmitter. The patient then drinks a solution of water and bicarbonate of soda, which normally stimulates the release of stomach acid. The pH is transmitted to a receiver that is placed on the outside of a person's body near the stomach, and the fluctuations in pH are plotted on a graph, called a gastrogram. After the test, the capsule passes through the digestive tract and is excreted.

Natural Treatments For Hypochlorhydria

Your Stomach, Part 1
Date: 10/12/2009
Posted By: Jon Barron
Edited To Fit This Format

In Part 1 of our series on the digestive system, we overviewed the process whereby food enters the mouth and passes through the GI tract and on out through the anus. We also focused on the process of actually getting food into the stomach through the mouth and esophagus. And finally, we discussed how enzymatic digestion begins in the mouth, but for most people, because of diet and eating habits, never actually amounts to much.

We now pick up the process as the bolus of food arrives in the cardia of the stomach -- which brings us to our first key point of the day that although the stomach has no actual physical separations, it does not function as an undifferentiated sac.

The Divisions Of The Stomach

Anatomically, the stomach is not so much a separate organ as it is an enlargement (like the esophagus) of the intestinal tract that sits just below the diaphragm. In fact, the only thing that separates it from the rest of the GI tract are areas at its top and bottom that use muscles to constrict and close it off from the esophagus and the duodenum on either end respectively. Its functions are very simple: to grind, mix, digest, and parcel out its contents to the intestinal tract in a slow, controlled manner.

Although it is a single cavity (again, just part of the GI tract), it has four main "functional" divisions. Physiologically speaking, they are:

The chyme moves through these divisions sequentially, rather than just dumping into one great cavity. This distinction is crucial to understanding the digestive process. Unfortunately, although medical doctors understand the sequential nature of digestion in the stomach, they do not fully understand what it means. And once again, That's because they base their assumptions on observation; and when it comes to observation, 99.9% of the people they see eat the typical highly processed, cooked food "modern" diet -- not the more natural diet our bodies were designed to handle. In other words, doctors' assumptions about digestion are based on observing people who eat badly, consume food totally devoid of live enzymes, and gulp their food down so quickly it barely has any time to mix with salivary enzymes. This gives a very distorted view of how the digestive process "should" work. And it has profound implications for our understanding of the digestive process and the things that can go wrong with it -- all of which, we will talk more about later.

For now, just understand that food moves through the divisions of the stomach sequentially. Among other things, this allows us to consume more than the intestines are ready for at one time. The divisions allow us to process the food slowly and prepare it for entry into the intestines in a controlled and measured manner.

The Layers Of The Stomach

The outer covering of the stomach is called the serosa. Its primary purpose is to carry blood vessels and to protect the stomach. The stomach is supplied by an extremely rich supply of blood vessels. Just under the serosa are the layers of muscle -- longitudinal, circular, and oblique.

As you can see from the illustration to the right, these muscles allow the stomach to bend, twist, and fold in almost any direction. Combine all of that motion with the folds (rugae) in the interior of the stomach (as shown in our previous illustration of the stomach's divisions) and it's easy to see how the stomach can easily "grind" food down and totally mix it up with any digestive enzymes and juices that are present.

One final layer that we need to talk about is the thick, plush layer of mucosa cells that line the stomach cavity. It has deep clefts that increase the stomach's surface area considerably. There are four different types of mucosa cells.

Digestion

There are two main kinds of digestion processes in the stomach:

Mechanical digestion is defined by the stomach's mixing of the chyme, whereas chemical digestion is defined by the action of various acids, hormones, and enzymes on the chyme.

Mechanical Digestion

After the bolus drops into the cardia, it is pushed up into the fundus, where it is held for upwards of 40-60 minutes with minimal stomach acid being produced -- about 30% of full levels and not enough to render digestive enzymes inactive. It is while in the fundus that enzymatic digestion (from live enzymes present in the food, salivary enzymes introduced while chewing, or supplemental digestive enzymes taken with your meal) takes place. Up to 75% of digestion can take place during this phase -- or none at all if there are no enzymes present. Since any sustained heat of approximately 118-129 degrees F destroys virtually all enzymes, it's easy to see why the modern diet is pretty much devoid of live enzymes. Add to this the fact that the vast majority of people don't really chew their food but, rather, gulp it down -- thus missing out on salivary enzymes as well -- and you have the very real potential for zero enzymatic digestion taking place in the fundus.

Once again, enzymatic digestion is almost never accounted for in medical texts because doctors rarely see it. Again, ninety-nine percent of their patients eat cooked/processed food that is devoid of digestive enzymes and chew their food minimally so there is very little salivary action on the food. In any case, when doctors look at the cardia and fundus, they primarily see holding areas where virtually no enzymatic digestion takes place.

One nod the medical texts do give to the fundus is that it's where ghrelin is manufactured. Ghrelin is a hormone produced mainly by the P/D1 cells lining the fundus. The key role ghrelin plays is that it stimulates hunger. It is considered the counterpart of the hormone leptin, produced by fatty tissue, which induces satiation when present at higher levels.

In any case, at the end of "fundal" cycle, whether any enzymatic digestion has taken place or not, the chyme is moved down into the body of the stomach, where stomach acid is introduced at full levels, thus neutralizing all enzyme activity. Very little mixing takes place in the cardia or the fundus (again, these areas are reserved primarily for enzymatic digestion) but commences full force once the chyme is in the body of the stomach. In fact, waves of peristalsis (muscle contractions) grind and mix the food once in the body. This action is aided by the rugae, or folds, in the interior of the stomach, which force the chyme to roll over and churn as the muscular contractions squeeze the chyme over the folds.

After a period of intense mixing and digestion, the chyme moves from the body of the stomach into the antrum, where it is held up. The body knows that the duodenum is very small. Therefore, only a small amount of chyme is allowed into the duodenum at any given time; the rest remains in the antrum for additional mixing and grinding and additional chemical digestion. In fact, the major chemical processes take place, not in the body of the stomach, but in the antrum while chyme is waiting its turn to pass through the pyloric valve.

And with that stated, now let us take a closer look at these chemical processes.

Chemical Digestion

When we refer to chemical digestion, we're talking about the action of hydrochloric acid and pepsin (or parietal cells and chief cells) on the chyme. At its most basic level, chemical digestion is about taking big molecules and breaking them down into smaller molecules. Note: enteroendocrine cells are also active in the stomach, but (as we will discuss later) they play a regulatory role, rather than a digestive role. Let us now look at the different cells in the stomach that play the major roles in chemical digestion.

Parietal Cells

There are some parietal cells in the fundus, but most are in the body of the stomach and the antrum. The parietal cells are extremely important as they secrete hydrochloric acid (HCL) in very high concentrations.

HCL Performs The Following Functions:

Chief Cells

Pepsinogen is secreted by the chief cells. By itself, pepsinogen is inactive and will digest nothing until it is converted into pepsin when it comes in contact with the hydrochloric acid in the stomach. Pepsin is an extremely powerful protein digestive enzyme that thrives in a high acid environment. Pepsinogen converts to active pepsin only at low (high acid) pH. This is actually a remarkably elegant maneuver by your digestive system. Since pepsin literally digests protein, you don't want pepsin active in the mucosal/chief cells or it would digest them. Thus the mucosal cells release pepsinogen, pepsin's precursor -- which is converted into pepsin only after the pepsinogen has made its way out of the chief cells and into the stomach itself, where it is converted in the presence of stomach acid. Since the wall of the stomach is coated with a glycoprotein mucous, the pepsin can only digest your meal and not your stomach.

As we discussed already, stomach acid doesn't actually digest protein; it merely unfolds the proteins. That's where pepsin comes in. Pepsin is what actually breaks bonds between amino acids that make up proteins; thus, it is the pepsin that literally digests proteins. (Actually, it breaks them into "peptides," which are smaller chains of amino acids.) And once again, if your body is getting the benefit of full enzymatic digestion in the cardia and fundus, it will digest up to 75% of the proteins in your meal before HCL and pepsin ever come into play. This means that in proper digestion, HCL and pepsin should only be required to do clean up duty. But without enzymatic digestion, your body is required to increase HCL and pepsinogen production by some 400% to make up the difference. Once again, this is a major body stressor with profound long term consequences.

Pepsinogen serves one other key function in the stomach: it plays a significant role in moving chyme through the digestive tract. Or in "medicalese," it increases gastric motility. It accomplishes this in two ways. First, it is the arrival of pepsinogen that plays a key role in telling the esophageal sphincter to close down so that food and stomach acid can't back up into the esophagus. Pepsinogen then works at the other end of the stomach by telling the pyloric sphincter to open, thus allowing food to exit the stomach and make its way into the duodenum.

The chief cells also secrete gastric lipase, which breaks triglycerides into fatty acids and monoglycerides. Unlike triglycerides, fatty acids and monoglycerides are usable by your body and do not promote heart disease. It should also be noted that because gastric lipase is active at a pH of 3 to 6, its role is somewhat limited until it enters the duodenum, where stomach acid is neutralized and pH is raised. Another note is that although salivary lipase and gastric lipase are overshadowed by the later action of pancreatic lipase in the intestinal tract, if allowed to do their job, the action of salivary and gastric lipase can significantly reduce the burden of pancreatic lipase in the intestinal tract. Once again, we pay a price for our modern diets -- unless we supplement with digestive enzymes.

Enteroendocrine Cells

Enteroendocrine cells, which are also known as G cells, are located primarily in the antrum and release gastrin which stimulates the production of both HCL and pepsinogen in the antrum and higher up in the body of the stomach. It is able to signal higher up in the stomach because the gastrin is released into the bloodstream and circulates around until it can enter the blood vessels that feed the stomach all the way from the esophageal sphincter to the pyloric valve. In addition to promoting digestive juices, gastrin causes the lower esophageal sphincter to relax; thus, high levels of gastrin are thought to play a role in the development of acid reflux disease since they cause the valve to relax too much and at inappropriate times. This will become significant when we talk about using antacids and proton pump inhibitors since by dramatically lowering HCL levels during digestion they cause a concomitant jump in gastrin levels in an attempt to ramp HCL levels back up. The net effect is a much "looser" esophageal valve thus allowing chyme to back up into the esophagus more easily. Taking this into consideration, high levels of gastrin may play a significant role in the development of acid reflux disease.

It probably should be mentioned that G-cells produce these higher levels of gastrin in response to antacids and proton inhibitors by proliferating wildly so that there are more of them to produce gastrin. So once again, artificially forcing symptoms back in line with pharmaceutical drugs has consequences. Although, to be fair, there is no evidence yet that this proliferation of cells leads to a malignant transformation in patients using the drugs. Then again, is that a risk you want to take?

Conclusion:

In our discussion of the stomach so far, we have learned exactly how the lack of enzymes in our food affects digestion and why supplementation with a good digestive enzyme formula makes sense. We have also picked up strong indications as to why antacids and proton pump inhibitor drugs may not be the best long term solutions to acid reflux. In fact, you may never look at your stomach in the same way again.

In our next issue, we will conclude our discussion of the anatomy and physiology of the stomach, as we:

And finally, we'll finish with the big payoff on our discussion of the stomach with an examination of the things that can go wrong and how to prevent and even cure them, such as:

Your Stomach, Part 2
Date: 10/26/2009
Posted By: Jon Barron
Edited To Fit This Format

In the last newsletter (part 1 in our series on the digestive system), we began our exploration of the anatomy and physiology of the stomach from a natural health perspective. In this issue, we finish that exploration by exploring the three phases of stomach digestion. This is crucial to understanding how to treat diseases such as acid reflux and peptic ulcers -- and why typical treatments such as antacids and proton pump inhibitor drugs that your doctor prescribes may actually make things worse long term. Along the way, we will return to our comparison of the digestive systems of carnivores, omnivores, frugivores, and humans to get a better handle on what we were designed to eat. And most importantly, we will begin to touch on those things that can go wrong inside the stomach and how you can prevent or correct them.

Gastric Secretion And The Regulation Of Food Moving Through The Stomach Goes Through Three Phases

The three phases of digestion (Cephalic, Gastric, And Intestinal) are regulated by both neural, blood, and hormonal factors, and there is much overlap and redundancy.

Cephalic Phase

The first phase is called the cephalic or neural phase. This phase actually occurs before food even enters the stomach and involves preparation of the body for eating and digestion. In fact, forget food entering the stomach. It can be triggered by the mere smell of food, or for that matter, just the thought of food. Sight, smell, and thought stimulate your cerebral cortex. Just think for a moment how the smell of your favorite dinner can make your mouth water, or how just thinking of eating can make your stomach growl and gurgle. Once your brain has picked up on the taste and/or smell of food, the stimulus is sent to the hypothalamus and the medulla oblongata (the reptilian part of the brain located in the brain stem). From there, it runs down the vagus nerve, which connects to every major organ in the body (except the adrenal glands) and specifically controls the cephalic phase of digestion in the stomach. The word vagus has the same root as the word vagrant and means much the same thing in the body - wanderer. The vagus nerve starts in the brain stem and runs down through your torso, playing a role in regulating everything from your heart and lungs to your stomach and intestines. In the stomach, the vagus nerve controls muscular contraction, telling the stomach to grind harder. It also stimulates secretion of HCL and pepsinogen and stimulates mucous production to protect against autodigestion of your stomach wall. And finally, it stimulates the release of gastrin from the antrum, providing yet another signal for the stomach to produce HCL. Gastric secretion during the cephalic phase rises to only 30% of maximum. Acidity in the stomach is not buffered by food at this point and thus acts to inhibit any further production of digestive juices.

As a side note, it is the vagus nerve that is triggered when we smell food or think about it (or hear a bell ring if you're one of Pavlov's dogs). It is that stimulus of the vagus nerve that starts us salivating in anticipation of food.

Gastric Phase

The second phase of stomach digestion/secretion is the gastric phase, which is both neural and humeral (humeral means things circulating in the blood). This phase is initiated by the presence of the bolus (the chewed up food when it is first swallowed) in the stomach. In fact, the gastric phase is activated by the stretching of the stomach wall as more and more food enters the stomach. Distention activates nerve reflexes in the stomach wall, which in turn activate the release of acetylcholine (a neurotransmitter) which stimulates the release of yet more gastric juices.

In addition, as protein enters the stomach, it binds to hydrogen ions, which raises the pH of the stomach from around pH 2.0-3.5 to pH 4.0 or higher. (Note: acids are defined by the number of H+ ions they hold in a solution. Thus, binding H+ ions makes a solution more alkaline.) As the pH climbs, inhibition of gastrin and HCl secretion is lifted. This triggers G cells to release more gastrin, which in turn stimulates parietal cells to secrete more HCl.

Everyone wants to know how strong stomach acid is. As released by the parietal cells in your stomach, stomach acid has a pH of about 0.8 to 1.0. Stunningly that's about the same strength as battery acid! However, as soon as it starts mixing with food, it will quickly rise to a pH of about 2.0 to 3.5 a pH your stomach will try and maintain for proper digestion. As more and more food enters the stomach, however, it continues to dilute the acid in the stomach, thus causing the pH to rise. Chemoreceptors in the stomach detect the rise in pH and signal the brain to produce more acid. In addition, as described above, protein in particular enters the stomach and binds to hydrogen ions, thus neutralizing some of the acid and raising the pH of the stomach. This rising and falling of pH in the stomach continues throughout the gastric phase, which lasts about three to four hours.

Once you understand the mechanisms of HCL production involved in the gastric phase, you can instantly understand the problem with using antacids such as Tums. Although they effectively can neutralize excess stomach acid short term, the very act of raising pH in the stomach while food is present tells the body to produce more acid to compensate. Thus, you get short term relief, followed immediately after by another round of excess stomach acid. On the other hand, moving chyme on through the stomach lessens the distension of the stomach, which signals that less acid is needed. In addition, eating live foods or using digestive enzymes with your meal allows for up to 75% of the meal to be digested by enzymatic action, cutting the time needed for gastric digestion by three - quarters - thus moving chyme through the stomach that much faster. This cuts stomach acid levels in two ways:

Incidentally, the gastrin produced by the enteroendocrine cells in the antrum is not released directly into the stomach, where it would be unable to trigger HCL production in the body of the stomach because cells in the stomach wall are protected by a layer of mucous. Instead, it is released into the bloodstream, where it then circulates back to the blood vessels that feed the stomach, where it can then trigger the parietal cells in the body and antrum of the stomach. As stated earlier, gastrin circulating in the bloodstream also shuts the esophageal sphincter and opens the pylorus leading into the duodenum and the small intestine. The total effect is to force a small amount of chyme across the pylorus into the duodenum. As one might imagine, this has implications for acid reflux disease, which we'll talk more about in our next newsletter.

The intestinal phase refers to that part of digestion/secretion triggered when chyme reaches the duodenum. The high acid chyme triggers three events that affect the stomach.

  1. First, the distension caused by the chyme entering the duodenum sends impulses to the brain that then sends signals down the vagus nerve telling the stomach to stop producing stomach acid.
  2. Distension also causes direct nerve stimulation of the stomach telling it to stop producing gastric juices.
  3. And finally, the distension and the high acid content of the chyme cause the pyloric sphincter to tighten thus preventing any more food from entering the duodenum. In effect, the intestines slow down gastric digestion and emptying to give themselves more time to prepare for food. The more chyme that goes into the intestines, the more the intestines try to say, Slow things down. I need more time.

At this point, it's worth taking a look at some numbers involved here. The pyloric region of the stomach holds about 30 ml of chyme (about 1 oz). It allows only liquids and small particles of chyme, about 3 ml at a time, to pass through the valve with each peristaltic wave (when the valve is open). The contractions of the pylorius decrease the opening of the valve as does the action of gastrin. This results in the majority of the chyme remaining in the stomach getting remixed again and again. Since the rate of peristaltic waves is a constant three per minute, that means the stomach only passes about one-third of an ounce of chyme into the duodenum per minute again, when the pyloric valve is open. Thus it takes approximately three to four hours for an average meal to fully pass from the stomach. During that time, as each tiny wave of food enters the duodenum, the duodenum sends out its excitatory and inhibitory signals. Larger than average meals can take many hours longer to clear the stomach.


Peristalsis In The Antrum Of The Stomach

Duodenum

Although the duodenum is more anatomically aligned with the small intestine than the stomach, physiologically it is more oriented to digestion than absorption. In any case, we will quickly examine the duodenum in this newsletter.

Anatomically, the duodenum is defined as the first 12 inches of the small intestine. Very little absorption takes place in the duodenum -- mostly just transport and mixing. Its primary roles are to signal the stomach when to stop producing stomach acid, to regulate the flow of chyme into the intestinal tract, neutralize the hydrochloric acid in the chyme, and to start the digestive juices and insulin flowing from the pancreas and gallbladder. Also, as we discussed earlier, the duodenum releases three hormones when chyme (especially fatty acids and glucose) enter the duodenum. These are:

Gastric Emptying

Gastric emptying is promoted by the distension of the antrum, partially digested protein fragments (amino acids), and drugs such as alcohol and caffeine.

That's why having a cup of coffee in the morning or a drink before dinner stimulates hunger, because it causes the stomach to empty, decreases distension, which triggers hunger.

On the other hand, as we just discussed above, gastric emptying is inhibited by distension of the duodenum as food enters and by the presence fatty acids, glucose, and protein fragments in the duodenum. These are all triggers to slow the emptying of the stomach's contents. In addition, increased secretion of CCK (cholecystokinin), secretin, and GIP (gastric inhibitory peptide (hormone) slow down gastric emptying.

As we discussed earlier, it takes about three to four hours for an average meal to completely empty from the stomach. However, that said, different types of food move through at different rates. Fatty foods remain in the stomach for the longest time; proteins remain an intermediate time; and carbohydrates remain for the shortest time. Although proponents of proper food combining would have a heart attack to hear this, combining all three elements (proteins, fats, and carbohydrates) at a meal provides the longest lasting sense of satiety. Quick signals from carbohydrates tell the brain you're full, followed by protein signals, and finally by fat signals. All telling your brain that you're still working on the meal and that you're still satiated. Diets that concentrate on only one element do not prolong satiety.

That said, proper food combining addresses an entirely different issue. By combining proteins fats and carbohydrates in the proper manner and not mixing bad matches in any given meal, you optimize the digestive process for those particular foods. Now it is certainly true, as many medical experts have stated, that much nonsense has been spouted in the name of food combining. And it is also true that it does not produce the same levels of satiety as seen when mixing foods. However, proper food combining absolutely minimizes gas and intestinal distress and leaves you feeling more energized after eating.

On a related note, it should be mentioned that your stomach has the capacity to stretch significantly. In fact, not only can the stomach stretch quite a bit, but it tends to collapse quickly when stretched, causing hunger to return quite soon after a large meal. How far can it stretch? After a Thanksgiving dinner, it can stretch almost down to your pelvis. Then it empties and you feel hungry again.

Grazing on the other hand does not overstretch the stomach, and keeps some food in there most of the day, which means you are constantly sending satiety signals to the brain. In other words, 6 small snack/meals will keep you feeling more satiated than 3 large meals, or any large meals, for that matter.

Carnivore, Omnivore, Frugivore

Now, having taken a comprehensive look at the anatomy and physiology of the human stomach, let's continue our comparison of intestinal tracts.

Carnivore And Omnivores

We can group these two sets of animals together, since the differences between the stomachs of the two are minimal. For both groups, the majority of digestion occurs in the stomach (which, as you can see from the lion's stomach on the left, is rounder and more sack-shaped than the human stomach and has a much higher concentration of acid for digesting not only animal tissue, but also bone as anyone who has seen the movie Snatch knows). In fact, the stomachs of carnivores and omnivores secrete powerful digestive enzymes and digestive juices with about 10 times the levels of hydrochloric acid found in a human stomach. To be precise, the pH in carnivores and omnivores with food in their stomachs is less than or equal to about 1.0. For humans, on the other hand, pH ranges from 2.0-4.5 with food in the stomach. This is a huge difference.

Another difference is that food usually remains for days at a time in a carnivore's stomach while it is digested (to a large extent) by enzymes present in the raw meat itself (a process called autolytic digestion). It is only after autolytic digestion that the highly concentrated HCL makes its appearance to break down the bone and gristle consumed with the meal. In addition, carnivores are adapted to process huge amounts of food at a time (up to 25 percent of their body weight or more) then eat nothing for days at a time. This doesn't sound very much like the human digestive process (except on all-you-can-eat nights at the Troff N Brew Restaurant)

Frugivore

And, as might be expected, the human stomach is remarkably similar to the chimpanzee's stomach, both in terms of shape and gastric juice content. Using that as a guide, we once again are looking at a diet that consists largely of fruits and nuts, with a maximum of about 3% meat. Again, as explained two newsletters ago, the human digestive system is remarkably adaptable but there are consequences when it is forced to adapt.

Conclusion

This concludes our discussion of the anatomy and physiology of the stomach. In our next newsletter (part 4 in our series on the digestive system), we will focus in on the primary stomach disorders of our time and how they can be addressed using natural health alternatives:

And as part of our discussion of acid reflux disease, we will also explore the impact of suppressing stomach acid production on:

Your Stomach, Part 3
Date: 11/09/2009
Posted By: Jon Barron
Edited To Fit This Format

In the last newsletter, we concluded our discussion of the anatomy and physiology of the stomach from a natural health perspective. In this issue, we take the logical next step and explore in detail the things that can go wrong with your stomach. Amusingly, the common stomach ache is not one of them. When most people complain of a stomach ache, they put their hands over their transverse colons, the source of the problem and an area we will cover in great detail later in our series on the digestive system. But for now, our focus will be on stomach/duodenal specific problems.

These Include:

Peptic Ulcers

Most people do not understand ulcers. They think they are either caused by too much stomach acid (not true) or caused by the bacteria H. pylori (only partially true). They also think most ulcers occur in the stomach (gastric ulcers), which again is not true. In fact, about 60% of all peptic ulcers occur in the duodenum, where stomach acid is actually neutralized shortly after making its appearance, which surprisingly contributes to the problem.

Quite simply, a peptic ulcer is any ulceration in acid-exposed areas in the duodenum or stomach. Stomach acid itself is not the culprit here. After all, strong stomach acid is a normal part of digestion. In fact the key to understanding peptic ulcers lies in two words found in the definition above: "acid-exposed." The bottom line is that peptic ulcers occur when the mucous that lines every square inch of the stomach and duodenum and that protects them from the corrosive effects of stomach acid is somehow worn away from an area of tissue, exposing that tissue to the burning effects of the acid. Peptic ulcers, then, are caused not by stomach acid, but by damage to the body's protective mucosal lining.

This Can Have Several Causes:

Helicobacter pylori (H. pylori) is considered the primary culprit. Although somewhat resistant to stomach acid, H. pylori bacteria cannot really withstand a full onslaught of undiluted acid. Therefore, it lives under the mucosal layer lining the stomach, but does not actually invade it. It thus protects itself from the gastric juices, which can destroy it. H. pylori further protects itself by secreting urease, an enzyme that breaks down urea into ammonia and carbon dioxide; the ammonia in turn neutralizes stomach acid. This helps it survive short bursts of exposure to less than full strength stomach acid as it makes its way through the stomach and on into the duodenum. As the organism thrives and expands its colony under the mucosal lining, it causes the lining to inflame. This causes a thinning and breakdown of the mucous layer that protects the lining. The lining of the duodenum or stomach is now exposed to acid and pepsin, and ulcers may develop.

So again, stomach acid does not directly cause the stomach ulcer, (and here's an important point) can actually kill the bacteria if it is strong enough and is present before the bacteria can establish itself under the mucosa. If stomach acid is diminished for any reason (such as regular use of proton pump inhibitors, excessive use of antacids, or regular consumption of large amounts of liquids with meals), this can allow the bacteria the opportunity to survive long enough to establish itself in the mucosal lining protected from stomach acid. This can lead to a very interesting paradox.

Currently, proton pump inhibitor drugs are your physician's primary option for treating ulcers (along with antibiotics to kill the H. pylori) since they prevent your stomach from producing the stomach acid that is eating away at the exposed tissue. But without sufficient stomach acid, the bacteria can resist lower levels of stomach acid. That's why the standard medical treatment for H. pylori requires antibiotics to kill the bacteria. The problem with this form of treatment, however, is that it may actually make the condition worse. What a quandary! In addition, when discussing H. pylori, it should be mentioned that only a small minority of people (5-10%) who have H. pylori in their system ever develop a peptic ulcer. Not just a quandary, but a paradox too!

The other two primary causes of peptic ulcers are non-steroidal inflammatory drugs (NSAIDS) and "social" drugs such as nicotine from smoking, alcohol, and caffeine. Many NSAIDS (especially aspirin) and corticosteroids irritate the stomach lining and can also cause ulcers. As for smoking, people who smoke are more likely to develop a peptic ulcer than people who do not smoke, and their ulcers heal more slowly. As for spicy foods and being stressed, they can make your ulcer "feel" worse, but there is no established link between them and the actual formation of peptic ulcers.

An Alternative Approach To Ulcers

Supplemental digestive enzymes help digest so much of your meal during the 40-60 minutes of pre-digestion that your body requires a less sustained release of acid in the actual digestion phase. (Note: the strength of the stomach acid released is undiminished, only the time of exposure is reduced.) This means that taking digestive enzymes will lessen the amount of time that your stomach and duodenum are exposed to acid -- but without raising pH when the acid is actually present. Those who suffer from chronic low levels of acid need not worry. Digestive enzyme supplements help here too by breaking down so much food in the pre-digestion phase that less acid is actually required overall. And over time, decreased demand results in increased reserve capability.

In addition, protease released with the stomach acid or present in the supplemental enzymes will begin breaking down the protective coating of the H. pylori bacteria. In other words, the protease will actually begin to digest the bacteria, rendering it vulnerable to stomach acid. However, for those with a severe existing ulcer, the protease may begin to digest damaged mucosal tissue because its protective coating is missing. This can cause noticeable discomfort for several days. To avoid this, when using digestive enzyme supplements, start with very small amounts of the supplement with your meals and build up slowly.

And Then there's Mastic!

Mastic, which is widely used in Mediterranean cooking as a sweetening agent, offers a couple of interesting health benefits. First, studies now indicate that in addition to having direct antimicrobial activity, mastic renders H. pylori vulnerable to your body's immune system. Mastic also enhances your body's ability to regenerate the epithelial cells of your gastrointestinal lining. The net result is that mastic can help prevent and relieve a number of digestive disorders, including heartburn, gas, bloating, dyspepsia, nausea, and of course, peptic ulcers.

Acid Reflux

Acid reflux disease, also known as Gastroesophageal reflux disease or GERD, is defined as chronic symptoms or mucosal damage produced by the abnormal reflux of food and digestive juices (chyme) back up into the esophagus. This is commonly due to malfunctions in the lower esophageal sphincter that is supposed to prevent reflux from the stomach, back up into the esophagus, and to loss of control of acid production during the digestive process. Surprisingly, most treatments deal only with the second factor, not the first.

Before we can actually cover the causes of acid reflux and what you can do about it, we need to quickly review from the last newsletter, the phases of acid release, the regulating mechanisms that govern its release, and the triggers your body uses to signal for increased production of stomach acid. Understanding these triggers becomes the key to managing them and also exposes the flaws in the basic medical approach.

As we discussed last issue, there are three phases of stomach acid release. To quickly review:

Cephalic Phase

Thirty percent of stomach acid is released by the anticipation of eating and the smell or taste of food. This is known as the cephalic phase, and as we will discuss in a bit, this is both governed and triggered by the vagus nerve. The vagus nerve starts in the medulla oblongata of the brain, runs down through the neck and then connects to virtually every organ in the body except the adrenal glands. As such it plays a major role in the digestive process -- both sensing what's happening in the stomach and signaling the stomach to prepare for the ingestion of food.

Gastric Phase

Sixty percent of all stomach acid is released during the second phase of digestion, the gastric phase. This phase is triggered by the distention of the stomach -- primarily the lower part of the stomach (the antrum) as chyme (the mixture of food and digestive juices) makes its way through the digestive process -- and by the presence of proteins in the stomach. It is also triggered by a sudden rise in pH as stomach acid is diluted and if there is too little calcium in the blood. These four triggers cause gastrin, the primary regulator of stomach acid production, to be released. As we discussed in the last newsletter, gastrin is released into the bloodstream by the G cells located in the antrum of the stomach. Once in the bloodstream, gastrin circulates around body -- ultimately reaching the cells of the stomach wall via the rich blood network that supports the stomach and bathes all of the cells in the stomach wall. Once there, gastrin works by stimulating the pariatel cells and the gastric chief cells to produce stomach acid and pepsinogen respectively as needed for digestion. In addition, gastrin causes the lower esophageal sphincter to constrict, thus inhibiting the backup of chyme and stomach acid into the esophagus. Disrupting this signaling mechanism causes the sphincter to relax, thus making it more prone to reflux.

Since these triggers for the release of stomach acid are so important, let's review them in a little more detail.

Intestinal Phase

And finally, ten percent of stomach acid is released during the last phase of digestion, the intestinal phase. This is triggered when chyme begins leaving the stomach and causes distension of the duodenum. More importantly, though, the presence of chyme in the duodenum starts triggering the inhibition of gastrin release -- and ultimately the inhibition of stomach acid production. This is regulated by the fact that the presence of chyme in the duodenum triggers the release of a number of hormones, including somatostatin, secretin, VIP, glucagon, calcitonin, and, of course, the appropriately named gastro inhibitory peptide.

Solutions To Excess Stomach Acid

So now that we know the mechanisms that regulate the production of stomach acid and the triggers that lead to excess production in the stomach, we should be able to look at the alternatives for alleviating the condition -- and what problems they might present.

Antacids

As we discussed last issue, once you understand the triggers involved in the production of stomach acid, you can instantly understand the problem with using antacids such as Tums and Rolaids. Although they effectively can neutralize excess stomach acid short term, the very act of raising pH in the stomach while food is present tells the body to produce more acid to compensate for the reduced acid levels. Thus, although you may get short term release from antacids, it is likely to be followed by another round of excess stomach acid.

Drinking water

Drinking water to dilute excess stomach acid presents pretty much the same problem as using antacids. It will neutralize excess stomach acid short term, but by raising pH while the stomach is still distended, it will merely trigger the subsequent production of even more stomach acid.

Which brings up another issue associated with drinking water (or other liquids) while eating.

Drinking too much liquid while eating will dilute stomach juices from the get go. Not only does that interfere with digestion, it also immediately triggers the stomach to produce more stomach acid and is a primary factor in the onset of acid reflux disease. A little bit of water, wine, tea, whatever with your meal does not present a problem. Once you go beyond 8 ounces, however, problems start to develop. The more you drink, the greater the problems. Or to put it another way, three slices of pepperoni pizza sluiced down with an entire pitcher of root beer is a prescription for disaster.

Proton Pump Inhibitors

"Proton pump inhibitors" is the name of class of drugs that includes familiar names such as Nexium, Prilosec, and Prevacid. Right now, within the medical community -- and within the public at large -- proton pump inhibitors are among the hottest drugs in use. This is a testament both to the extent of digestive problems in the developed world and in the ability of these drugs to effectively stop production of excess stomach acid. How do they accomplish this miracle?

Without going into technical details, suffice it to say that proton pump inhibitors act by blocking an enzyme system that controls the final stage of the release of stomach acid from the parietal cells. Block the enzyme system, and you stop the release of stomach acid. How effective are proton pump inhibitors in stopping the release of stomach acid?

Quite simply, proton pump inhibitors can reduce gastric acid secretion by up to 99%.

Problem solved! If you had acid reflux before, you do not now. Even if some chyme is still backing up into the esophagus, it's not a problem since there's no stomach acid present. For doctors, it's the perfect solution. It works like a charm, and their patients are happy.

However, since it doesn't address the actual problem behind acid reflux and merely suppresses a symptom (which is in fact what most drugs do), it should not be surprising that there is a physical cost to regular use of these drugs.

But even more significantly, there is a fundamental problem with suppressing the production of stomach acid. Hydrochloric acid is not just "something" in the stomach; it is an essential component of the digestive process. Suppressing the symptoms of acid reflux by eliminating 99% of all stomach acid production presents a fundamental disruption of the digestive process. As you may remember from the last newsletter, hydrochloric acid is required for the digestion of proteins; it unwinds them so that pepsin can break them down. It is also required for the absorption of nutrients, particularly of vitamin B12. And it is required for the utilization and absorption of minerals such as calcium. Specifically, suppressing the production of stomach acid through the long term use of proton pump inhibitor drugs will lead to:

Incomplete Digestion

Stomach Acid denatures (unfolds) proteins so that they can actually be broken down by pepsin during digestion. Without being unfolded, they resist digestion. Without sufficient stomach acid present, this process won't happen and the digestion of your food -- particularly proteins -- will be incomplete. This can result in long term deficiencies. In addition, since proteins now enter the intestinal tract not fully digested, this puts incredible stress on your pancreas (the digestive organ last resort, as it were) to produce vast quantities of protein digesting enzymes to try and compensate. And of course, the incomplete digestion of complex proteins (particularly those found in wheat, corn, and dairy) is a major factor in the onset of food allergies.

In addition, HCL kills many micro-organisms, such as the ones that travel into the digestive tract from the human mouth or come breeding in the food itself -- as with contaminated meat or produce. Without sufficient stomach acid present, you are that much more likely to succumb to food poisoning and stomach flus -- not to mention H. pylori and peptic ulcers, as we discussed earlier.

It is the presence of HCL in both the stomach and the duodenum that stimulates the flow of hormones, bile juices, and pancreatic juices in preparation for release into the small intestine. The less HCL produced, the less pancreatic juices are signaled for. Combine low HCL with no digestive enzymes being consumed with your food, and you have guaranteed lack of proper digestion (not just for proteins, but for fats too since the trigger for the release of bile has been disrupted).

Poor B12 Absorption

Intrinsic factor is a protein made by the parietal cells in the stomach. It is made and released concurrently as the parietal cells make and release stomach acid. Effectively, the same things that trigger the release of stomach acid trigger the release of intrinsic factor -- and more to the point, the same things that inhibit the release of stomach acid, such as proton pump inhibitors, inhibit the release of intrinsic factor.

Why Is This Important?

Because intrinsic factor is essential if your body is to absorb and utilize vitamin B12. The mechanism is simple. Intrinsic factor, if it's present, binds with vitamin B12 in your food and/or supplements. This happens in the duodenum, and it accomplishes two things:

Without intrinsic factor, most B12 could never reach the ileum, and even that which made it there could not be swapped out with transcobalamin II and thus utilized by the body. This means that if there is an intrinsic factor shortage, you will suffer from a B12 shortage, no matter how much you supplement.

The primary symptom of B12 shortage is pernicious anemia, a decrease in red blood cells that occurs when the body cannot properly absorb vitamin B12 from the gastrointestinal tract.

Symptoms Of Anemia Can Include:

In people with anemia, the heart has to work harder to pump blood to get enough oxygen to the body's organs and tissues. This stress on the heart can cause heart murmurs (an extra or unusual sound heard during the heartbeat), fast or irregular heartbeats, an enlarged heart, or even heart failure.

Related symptoms include:

Related Symptoms Include:

Not surprisingly, pernicious anemia is a known side effect of the long term usage of proton pump inhibitors. And in fact, the problem is even worse than described above. In addition to causing B12 shortages, long term use of proton pump inhibitors leads to iron deficiency, which further exacerbates the problem by causing iron deficiency anemia, as we will now discuss.

Poor Mineral Absorption

Hydrochloric acid is essential for separating minerals from the foods that bind them. Or, if the minerals are already separated, as in supplements, low HCL levels in the stomach allow the minerals to recombine with the chyme into compounds that are difficult to absorb. Some minerals are more prone to this problem than others. Of the major minerals, iron, zinc, and calcium absorption in particular are directly affected by low acid levels.

In addition, if the stomach produces too little stomach acid, minerals such as calcium remain insoluble and cannot be ionized, which is necessary for assimilation in the intestines. Ionization is the process whereby an atom changes its structure so that it can combine with other elements. This is why chelated calcium, like many other chelates, is much more absorbable than raw calcium. The bottom line is that proper stomach acid levels are essential for ionic bonding which is necessary for intestinal uptake. The proper level of hydrochloric acid in the stomach is so important that its lack in the digestive process can account for as much as an 80% loss of available calcium absorption.

That means that regular users of proton pump inhibitor drugs are prone to be deficient in these minerals. In addition, sufficient stomach acid is essential for the absorption of most trace minerals. And considering that most people get almost none of these essential micronutrients in their diets to begin with, deficiencies of trace minerals is epidemic among people who suppress stomach acid production.

There's More

In addition to the problems we've already discussed relative to B12 and minerals, the symptoms of HCL deficiency include:

The bottom line is that despite the fact that proton pump inhibitor drugs can help eliminate the short term "symptoms" of acid reflux disease, they create a whole range of problems of their own associated with reduced stomach acid production and should not be used long term.

One final note on low stomach acid is that this is not just a concern for people who use antacids or proton pump inhibitor drugs. It is a major problem for the elderly. After a lifetime of eating enzyme deficient foods and forcing the stomach to overcompensate with extra high acid production, eventually the body's capacity to produce stomach acid breaks down. At that point, no matter what you do, the body can no longer produce enough stomach acid to properly digest foods or negotiate the absorption of vitamin B12 and minerals. That's one of the major reasons that so many of the elderly suffer from low blood counts and nutritional deficiencies -- particularly mineral deficiencies.

Natural Health Alternatives

Fortunately, proton pump inhibitor drugs are not the only solution to acid reflux disease. There are natural alternatives. These include:

And while discussing acid reflux disease, it's important not to forget the physical contributors to the problem

As we discussed in our overview of the digestive system, there are steps you can take to help alleviate hiatal hernias.

As for the esophageal sphincter, getting the release of stomach acid back into proper alignment and timing, can go a long way to helping the sphincter close properly -- as can avoiding overeating.

Satiety/Weight Gain

The human stomach can stretch quite a bit to accommodate a large meal, but also tends to collapse quickly after being stretched, which can cause hunger to return quite soon after a large meal. How much can it stretch? An unbelievable amount! After a Thanksgiving dinner, it can stretch almost down to your pelvis. Then it empties, eventually and you feel hungry again.

Grazing (eating a number of small meals throughout the day) on the other hand, does not overstretch the stomach, and keeps some food in there most of the day, which means you are constantly sending satiety signals to the brain. In other words, 6 small snack/meals will keep you feeling more satiated than 3 large meals -- or any large meals, for that matter.

When it comes to stomach stretching, I always remember the possibly apocryphal stories of Diamond Jim Brady, the American businessman and financier of the later 1800's, whose eating bouts were legendary.

No doubt, his appetite for gourmet food was insatiable, and he gorged himself at restaurants and parties. And as legend would have it, a typical Brady breakfast would include: eggs, pancakes, pork chops, cornbread, fried potatoes, hominy, muffins, and a beefsteak. For refreshment, a gallon of orange juice -- or "golden nectar", as he called his favorite drink. Lunch might be two lobsters, deviled crabs, clams, oysters and beef, with a few pies for dessert. The usual evening meal began with an appetizer of two or three dozen oysters, six crabs, and a few servings of green turtle soup, followed by a main course of two whole ducks, six or seven lobsters, a sirloin steak, two servings of terrapin and a host of vegetables. For dessert, he enjoyed pastries and a two pound box of candy.

Apocryphal or not, his lifestyle eventually caught up with him. Brady first consulted doctors for stomach diseases brought on by his uncontrollable eating habits: diabetes, heart and urinary problems, and high blood pressure. His prostate was swollen beyond belief. And his stomach was six times the size of a normal person's stomach. After treatment at Johns Hopkins in Baltimore helped clean the prostate,Brady went back to New York and lived lavishly for another five years.

But on April 13, 1917, Brady died of a heart attack resulting from complications of his diseases. He left most of his wealth to Johns Hopkins and New York Hospital to help found medical institutes in his name.

Good health and good appetite!

Conclusion

And here we conclude our discussion of the stomach.

When next we continue with our series on the digestive system, we will pick up with a discussion of those organs just outside the alimentary canal that play key roles in the digestive process, including the:

In some ways, these are three of the most fascinating organs in the body -- and three organs that are highly amenable to improvement through detoxing and flushing. Doctors absolutely do not understand the concept of detoxing when it comes to these organs, but we will explore the detox protocol using medical terminology and points of reference so that it will finally be understandable to them -- as well as to you.

Stomach Disorders Information: Natural News 10/19/2009 - Natural Remedies For Acid Reflux Disease (GERD)

Stomach Disorders Information: Natural News 12/7/2009 - Beware Of Side Effects Of PPI Drugs In Acid Reflux (GERD) Patients

Stomach Disorders Information: Natural News 1/20/2009 - Add Digestive Enzymes And Hydrochloric Acid To Relieve Gas And Bloating

Stomach Disorders Information: Natural News 5/27/2010 - Warning: Acid Suppressing PPI Drugs Have Serious Health Risks

Stomach Disorders Information: Natural News 12/2/2010 - Broccoli Extracts Prevent Stomach Disorders

Stomach Disorders Information: Heidelberg Gastric Analysis Test

Stomach Disorders Information: Fasting

Stomach Disorders Information: Dr. Ben Kim 5/31/2006 - Hiatal Hernia Treatment

Stomach Disorders Information: Dr. Ben Kim 2/10/2007 - Ginger

Stomach Disorders Information: Dr. Ben Kim 6/24/2009 - Why You Shouldn't Suppress The Urge To Burp Or Pass Gas

Stomach Disorders Information: Dr. William Campbell Douglass II 9/10/2002 - Peptic Ulcer Cause?

Stomach Disorders Information: Dr. Mercola 12/24/2000 - Diet For Inflammatory Bowel

Stomach Disorders Information: Dr. Mercola 12/31/2000 - Heartburn Drugs

Stomach Disorders Information: Dr. Mercola 2/17/2001 - Celebrex Does Not Lower Ulcer Risk

Stomach Disorders Information: Dr. Mercola 3/3/2007 - New Weapon To Fight H. Pylori

Stomach Disorders Information: Dr. Mercola 4/25/2009 - Acid Reflux Caused By Too Little Acid

Stomach Disorders Information: Dr. Mercola 9/5/2009 - Why You Should Get Off Prescription Acid-Reducing Drugs

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