Normal gastrointestinal function is virtually impossible without proper stomach acid secretion and a properly maintained pH. Inadequate stomach acid production can result in a sequelae of dysfunction throughout the rest of the digestive tract leading to maldigestion, malabsorption, inflammation, dysbiosis, toxicity, and autoimmune disorders.
In a healthy gastrointestinal tract, hunger signals from the brain initiate the digestive process by stimulating the secretion of saliva and gastric juices in preparation for food consumption. Upon entry into the mouth, mastication further stimulates digestive enzymes and gastric acid production in addition to mechanically breaking down food. Proper swallowing allows the bolus (chewed food) to pass into the esophagus, through the lower esophageal (cardiac) sphincter, and into the stomach.
Normal stomach acidity is between 1.5-3 pH and maintained via the production of HCL (hydrochloric acid) from the parietal cells of the stomach lining which are coated with a protective layer of mucous. The hormone gastrin (released in the antrum of the stomach), the neurotransmitter acetylcholine, and histamine (released from enterochromaffin-like (ECL) cells) are all involved in stimulating the parietal cells. Parietal cells are also responsible for creating intrinsic factor which is required for proper Vitamin B12 absorption. Chief cells in the stomach secrete enzymes that digest proteins (pepsin) which are only activated in the presence of adequate HCL levels. It is the acidity levels in the stomach that allow nutrients such as calcium, zinc, magnesium, iron, vitamin B12, and folic acid to be properly prepared for bioabsorption.
Muscular contractions of the stomach also help to mechanically digest the bolus eventually creating chyme which passes through the pyloric sphincter into the first part of the small intestine, the duodenum. It is the level of acidity of the chyme (which gets less acidic as it reaches the lower sections of the stomach due to the release of the somatostatin which slows gastric acid secretion) that triggers the next level of digestive events to properly occur. The acidic pH of the chyme stimulates the production of secretin which results in the release of pancreatic enzymes to further aid in digestion as well as the hormone cholecystokinin to facilitate the gallbladder to release bile for fat emulsification. The pancreas also responds to the acidity levels by producing bicarbonate to raise the pH of the chyme for continued transit along the small intestine. Without bicarbonate being triggered, the duodenum may be subject to developing ulcers.
In a normal system, once the mass has passed through the small intestine, much of the nutrients have been absorbed at this point. It now enters the large intestine via the iliocecal valve for further processing. The large intestine is the home to numerous colonies of beneficial (probiotic) bacteria which act in a symbiotic relationship with us. They help to further extract nutrients such as Vitamin K and B1, 2, and 12 and produce butyric acid which serves to nourish the colon. In a dysfunctional system where maldigested and malabsorbed food is being passed into the large intestine, dysbiosis may occur with pathogenic yeast and bacterial colonies outcompeting the probiotic ones. This can create inflammation, further nutrient deficiencies, and constipation further feeding the cycle.
In addition to enabling proper digestion of nutrients, a properly acidic stomach also prevents the overgrowth and invasion of pathogenic bacteria and yeasts. This includes H pylori bacterial overgrowth in the stomach which is associated with cancer and further dysregulated stomach acid production. When stomach acid is deficient, the undigested carbohydrates, fats, and proteins ferment, rancidify, putrify, and do not move forward into the small intestine propagating more dysbiosis. Pathogenic bacteria in the stomach and small intestine may further impair digestion by inhibiting bile salts and carbohydrate metabolism, facilitate water loss via diarrhea, and steal vital nutrients such as amino acids, vitamin B12, and folic acid producing toxins in the process. Without proper protein digestion due to inadequate acidity levels coupled with pathogenic bacterial consumption of essential amino acids there will be reduced production capability of vital neurotransmitters such as serotonin and norepinephrine. Deficiency of these neurotransmitters is associated with depression and chronic fatigue. Finally, the stasis of this rotting mass and resulting gases can build up and create reflux through the cardiac sphincter and irritate the esophageal tissue which is not designed to handle acidity. Therefore, it is ultimately a lack of acidity in the stomach that leads to gastroesophageal reflux disease (GERD).
As the toxic mass of improperly digested food eventually gets pushed into the small intestine it can create further damage to the villi and microvilli lining it. This will significantly impact the small intestine’s ability to absorb nutrients. If degradation of the small intestine’s lining continues these improperly digested food particles will leak out of the GI tract and into the bloodstream. The immune system reacts to these foreign particles as a pathogen and thus mounts an inflammatory response against them. This is how food sensitivities and allergies can develop. The immune system then starts to mistake similar chemical protein structures in the body such as the thyroid and other endocrine glands, connective tissues, nerve cells, and/or joints as pathogenic and autoimmune dysfunction can occur.
The concept of low stomach acidity as the real issue with digestive problems is in direct conflict with the current standard medical perspective that it is too much acid that creates the symptoms of heartburn and GERD. When the putrefied contents of the stomach leak out of the lower esophageal sphincter they are still relatively acidic and thus will damage the esophageal cells. However, the problem is that the mass is not acidic enough to allow the rest of the digestive cascade to properly occur. The practice of prescribing acid inhibitors (antacids, histamine (H2) blockers, and proton pump inhibitors) for managing reflux symptoms may temporarily relieve symptoms but is inherently exacerbating the problem.
There are a number or reasons why the medical community continues to epidemically prescribe acid blocking medications for GERD and indigestion problems. Probably the biggest one is the powerful influence the pharmaceutical industry has over doctors in addition to the general public through advertising. John Oliver recently did a story on “Big Pharma” (https://www.youtube.com/watch?v=YQZ2UeOTO3I) which gives further insight into this problem in a humorous manner. Furthermore, since drug companies are primarily driven by financial profits they will create products and patents that enable this. Many of the remedies that are suggested for stomach acid deficiency are inexpensive, natural, and thus not lucrative. Therefore, such treatments are unlikely to be promoted over profit inducing options. Furthermore, the process of getting approved by the FDA is very expensive and time consuming which further discourages small companies from producing herbal and homeopathic remedies and gaining traction in the medical community.
This leaves consideration of what natural treatment options are available to properly restore stomach acidity levels and thus improve digestive function further down the gastrointestinal tract. Below is a list of the “top 10” suggestions:
- Eliminate/reduce processed foods, grains (in particular gluten and non-sprouted), soda, sugar, caffeine, and alcohol. These types of food choices create additional strain on the stomach and esophageal sphincter.
- Consume smaller sized portions.
- Get parasympathetic. Proper digestion requires the autonomic nervous system to shift into a “rest and digest” phase. Eat meals in a relaxed manner and environment. Appreciate and truly enjoy what you are eating.
- Thorough chewing is essential to properly initiate the digestive process. Spend time chewing on each side of your mouth taking about 30 seconds per bite of food.
- Re-evaluate your current medications as they may be impeding your digestion. Bronchodilators, NSAIDS, certain calcium channel blockers and beta-blockers, Valium, Demerol, and Nitroglycerine can weaken the lower esophageal sphincter and muscles of the GI tract. Aspirin, NSAIDS (ibuprofen, naproxen), and some antibiotics (tetracycline) can directly irritate the stomach lining.
- Do not eat within 3-4 hours of going to bed. Use the force of gravity by being upright after eating to facilitate digestive transit.
- Consider doing an elimination diet of potential food allergies and sensitivities. The most common culprits are pasteurized dairy, grains (particularly gluten), soy, corn, and sugar. It is also possible to use your heartrate as a measure of food sensitivities. Take a 1 minute heartrate to establish a baseline in the seated position. Place the suspected food on your tongue for 30 seconds to establish the taste of it. While keeping it on your tongue retake your pulse. An increase of 6 or more beats per minute is indicative that the food is a stress to your system. You may spit out the food and test another in the same manner.
- If the esophagus and stomach are currently in a state of inflammation care must initially be directed at healing these tissues. Therefore, avoiding acidic foods (citrus, coffee) may be necessary initially. Professional assistance may likely be needed to guide one through this process of regeneration.
- The use of bitters, lemon water, or vinegar may help facilitate HCL production in the stomach. HCL and/or enzyme supplementation as well as numerous other nutritional and herbal remedies may be needed. Examples include wormwood, milk thistle, deglycyrrhizinated licorice (DGL), vitamin B12 (injection or oral), vitamin C, vitamin A, L-glutamine, zinc, turmeric, ginger, chamomile, probiotics, and many other options exist. Professional guidance is likely needed to help with the use of these treatment options.
- Last but certainly not least: Learn how to breathe and move properly. Efficient diaphragmatic excursion coupled with three dimensional rib cage deformation that should naturally occur during walking is necessary to facilitate gastrointestinal transit in addition to peristaltic contractions. The forces imparted by the thoracic respiratory cavity via gait and diaphragmatic breathing are transferred to the abdominal cavity in a pumping fashion to help propel intestinal contents. Good diaphragmatic function serves to constantly massage the stomach also contributing to stomach acid production. Furthermore, nasal breathing is desired over mouth breathing. Chronic mouth breathing is associated with orofacial dysfunction which can impact swallowing ability. Poor swallowing can result in the ingestion of air into the stomach and gut further degrading the digestive process. Furthermore, mouth breathing also impacts proper gas exchange and is associated with increased sympathetic tone (stress response). This can perpetuate food sensitivities and autoimmune reactions. The assistance from a professional with expertise in breathing, movement, and orofacial therapy may be needed.
References
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Matteoli, G., & Boeckxstaens, G. E. (2012). The vagal innervation of the gut and immune homeostasis. Gut, 62(8), 1214–1222. doi:10.1136/gutjnl-2012-302550
Boeckxstaens, G. E. (2013). The Clinical Importance of the Anti-Inflammatory VagoVagal Reflex.pdf. In R. M. Buijis and D.F. Swaab (Ed.), Handbook of Clinical Neurology. Elsevier B.V.
De Jonge, W. J. (2013). The Gut’s Little Brain in Control of Intestinal Immunity. ISRN Gastroenterology, 2013, 630159. doi:10.1155/2013/630159
Wright, J and Lane, L. (2001). Why Stomach Acid is Good for You.