Introduction

The stomach plays a key role in maintaining the integrity of the individual in the face of environmental challenge as it relates to the food that we eat.

The average individual will process about a ton of food and drink every month! It's the way that we handle and sort out this load that is very important in ensuring that the nutrients that we need get into the body and the chemicals, bacteria, toxins stay out.

The stomach plays a vital role in this process. By secreting hydrochloric acid and the hormone pepsin, it allows us to do the following:

1. break down and partially digest protein to prepare it for its next port of call in the duodenum and jejunum (the upper parts of the small intestine) for further breakdown into its component parts, the amino acids.
   
   
2. dissolve and put the minerals in our food into solution so as to be absorbable further down the gastrointestinal tract.
   
   
3. kill any potential disease causing bacteria and parasites which could potentially infect the intestines and allow their permanent unwanted residence in our bowels.

So when our ability to make hydrochloric acid is compromised, it can open the door to poor digestion, poor absorption and gastrointestinal infection.

This means that maintenance of optimal gastric function is vital to maintenance of good health.

Terminology

Here is a quick review of the terminology associated with stomach acid problems.

1. Hyperchlorhydria: means the production of too much tummy acid. This can cause corrosion of the stomach lining leading to stomach and duodenal ulcers.
   
   
2. Hypochlorhydria: this where the stomach doesn't make enough acid to do the job of handling food intake and performs its responsibilities in an inefficient way.
   
   
3. Achlorhydria: this is when the stomach makes no acid at all, its lining cells are flat and non-functioning. This condition is called atrophic gastritis.

How prevalent is hypochlorhydria?

It appears from research done in the 40's at John Hopkins University and the Mayo Clinic that low stomach acid was found in 30% of people by the age of 40, 60% by the age of 60 and 70-75% by ages of 70 to 75!

How relevant is this? Isn't this a normal effect of aging? Yes, it may be, but so is death. It has been common practice over the last 40 years to ignore this phenomenon in people and has been brushed aside as irrelevant by the traditional medical community.

However, hypochlorhydria and achlorhydria can lead to consequences in our health that are non-optimal and deleterious.

The Adverse Effects of Hypochlorhydria

These include:

1. Malnutrition
   a. amino acid deficiencies due to poor digestion and assimilation of protein. Low grade amino acid deficiencies can be associated with muscle wasting, immuno-deficiency, nervous system dysfunction and reduce liver detoxification.
   
   

   b. multiple mineral deficiencies particularly of calcium, iron, magnesium and possibly selenium, chromium, manganese, copper and other trace minerals.
   
   Deficiencies of these minerals can further cause ill health and increased risk to degenerative diseases.
   
   

   c. vitamin B12 deficiency. This is particularly seen in achlorhydric patients where there is no production of intrinsic factor. This is a chemical compound produced by the stomach which tags onto vitamin B12 released from protein in the stomach and carries it down the intestine to allow B12 to be absorbed in the lower part of the small intestine.
   
   

2. Food Intolerances
   When protein is poorly digested, partially digested fragments can gain access to the body and initiate an activation of the immune system causing conditions associated with food intolerance, e.g. arthritis, rhinitis, asthma, eczema, urticaria (hives) and colitis.

3. Colon Toxicity
   An increased lead of undigested protein fragments can get to the colon and feed a section of the flora there which overgrow, produce poisonous substances (like ammonia and various biogenic aminos) which are toxic to the body if allowed access to the general circulation. This is called putrefaction of the bowel.

Conditions Associated with Hypochlorhydria

These are numerous and include:

1. Patients with auto immune disease. These diseases include Type 1 diabetes, thyroiditis, lupus erythematous, rheumatoid arthritis, pernicious anemia, multiple sclerosis and so on. Clinical observation has elucidated that hypochlorhydria is present in 90% of lupus, 80% in rheumatoid arthritis and 60% in multiple sclerosis.
   
   
2. Patients on gastric acid inhibitory drugs and antacids are often hypochlorhydric before they even started these drugs in about 90% of the cases!
   
   
3. Asthma, especially in childhood. The incidence is around 80%.
   
   
4. Osteoporosis. In 90% of patients, as those patients with hypochlorhydria cannot assimilate calcium and other minerals well which are vital for bone integrity.

Signs and Symptoms of Low Stomach Acid

1. Capillary dilatation in the cheeks. This gives a rosy red complexion. There is a very high correlation with gastric hypoacidity, especially in younger persons.
   
   
2. Fingernails that break easily. This is generally seen in women. Nails tend to be paper thin, crack, chip or layer back.
   
   
3. Hair loss in women. One also sees this in women who are pregnant, on oral contraceptive pills or estrogen replacement therapy and in folic acid deficient individuals.



4. Abdominal bloating, in the upper part with consumption if animal protein, especially beef, when food just "sits there like a rock" and doesn't "digest" well.
   
   
5. Burping and belching.
   
   
6. Constipation.

Diagnosis

This is best done by performing the Heidelberg gastric pH analysis test.

This involves swallowing a capsule the size of a large multi-vitamin and mineral which has within it a pH electrode and a radio transmitter. The signal given off is sent to an antenna which the patient wears around the stomach in the form of a belt and the result is shown on a large machine which visualizes pH readings.

When safely swallowed and in place, resting stomach pH is measured. Except in severely achlorhydric patients, it is usually acid (pH of 1.8 to 2.3). The stomach is then made to work by the patient swallowing a known amount of sodium bicarbonate. When this is done, the stomach becomes alkaline and then acid is made to bring down the pH to the baseline.

In abnormal stomach this occurs within 20 minutes after 4 or 5 challenges. The reacidification time is delayed in these individuals with hypochlorhydria.

This procedure is very reliable in diagnosing sub-optimal gastric acidity states and confirms the clinical diagnosis.

Treatment

This usually involves swallowing "acid" pills in the form of Betaine HCL (with or without pepsin) or glutamic acid in fairly large doses (depending on the size of the meal eaten). The dose is usually four to six capsules of 650 mg capsules of Betaine HCL with a large meal.

Also, the stomach has to become acclimatized to this dose; so it is best to begin at one capsule during a meal and then increase by one capsule a week to the full dose.

Too much supplementation will cause stomach upset and therefore the dose should be adjusted accordingly. Smaller meals will require a lower dose.

Self-Medication

It is not advisable to supplement without being under the care of an appropriate health care professional. In fact, many people do self-medicate with no major problems, but it does happen that a normal stomach could get very irritated if a person decided incorrectly that hypoacidity was a problem.

Summary

Gastric hypoacidiy is a common problem and, as mentioned above, can be associated with many disease states and is often an underlying factor in chronic nutritional deficiencies in middle aged and elderly people, even when an adequate diet and supplements are consumed.

Therefore, its presence needs to be thoroughly looked for and treatment instituted, as it is much more difficult to manage a patient as effectively without intervening and handling this condition.

In fact, treatment of low stomach acidity can make a somewhat improved patient into a very improved patients.

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