Healthy digestion breaks down food into its smallest components (glucose, amino acids, fatty acids, vitamins, minerals, etc.) that are necessary for the body to perform all of its vital functions.
Digestion starts with chewing (mastication) as salivary enzymes begin breaking down food into its smallest basic units. After swallowing and passage through the esophagus, digestion continues in the stomach where hydrochloric acid and pepsin continue to break down food. Next, on to the small intestine where bile, bile salts, and enzymes from the pancreas and small intestine continue digestion and nutrients are absorbed. Lastly, to the large intestine (colon) for further absorption of water and nutrients and elimination from the body about 24 hours after food is eaten. A biomass of an estimated 8 pounds of healthy bacteria present in the colon also contributes to digestive and immune health.
Though we often think of malnutrition as resulting from limited access to food, malnutrition can exist even when adequate food is available if either nutrient-sparse junk foods are over-consumed or if digestion is impaired and vital nutrients cannot be properly broken down, absorbed, and delivered to the cells. Selecting, preparing, and eating all the right foods is of little use if the body cannot digest and absorb them. We are what we assimilate.
Digestion in the Stomach
Hydrochloric acid (HCl) is necessary to break down protein into amino acids and to extract minerals from food. HCl is made by specialized cells in the stomach lining called parietal cells. Upon merely seeing, tasting, or smelling food, the neurotransmitter acetylcholine stimulates parietal cells to make hydrochloric acid. Once food is in the stomach, histamine and gastrin also trigger HCl production.
A healthy stomach lining is designed to tolerate levels of hydrochloric acid that are one million times higher than surrounding tissues. Normal stomach pH is very acidic at 1.5 on a scale of 1 to 14, with 1 being the most acidic.
Parietal cells also produce “intrinsic factor,” a protein that binds to Vitamin B12, enabling its absorption.
Pepsin, an enzyme that breaks down protein into peptides, is also produced in the stomach by “chief” cells and is an important part of healthy digestion.
Though disturbances in digestion can occur at each of its many stages from chewing to elimination, the most common digestive disturbance occurs in the stomach and is called hypochlorhydria: the deficient production of HCl. The deficiency of HCl production occurs early in the process of digestion, a fact that impacts the effectiveness of all subsequent digestion in the intestines.
Causes of hypochlorhydria include aging, psycho-emotional stress, physical trauma, gastrointestinal viral infections, gastritis, chronic Helicobacter pylori infections, pernicious anemia, and chronic use of drugs including stomach acid blockers (proton pump inhibitors and H2 agonists) and steroids. Since HCl has a sterilizing effect in the stomach, the deficiency or lack of HCl can lead to bacterial overgrowth in the intestines. An estimated 50 percent of people over the age of 60 have low HCl levels, as do 50 percent of people who seek medical care for chronic health problems.
Effects of Hypochlorhydria
Signs and symptoms of hypochlorhydria include uncomfortable fullness after meals, numbness, tingling, undigested food in stools, thinning hair, Candida (yeast) overgrowth, rectal itching, and thin or peeling nails. The long term effects of deficient HCl are related to impairment of body functions that result from chronic nutrient deficiencies, specifically amino acids and minerals. As such, hypochlorhydria contributes to osteoporosis, allergies (including food allergy), cardiac arrhythmias, asthma, acne, ulcerative colitis, auto-immune illnesses (myasthenia gravis, Crohn’s disease, rheumatoid arthritis, pernicious anemia), psoriasis, depression, immune dysfunction, diabetes, celiac disease, vitiligo, hives, eczema, rosacea, and virtually all degenerative diseases. The likelihood of the true cause of hypochlorhydria being addressed is low because of the fact that the onset of these diseases occur years or decades after HCL declines.
Mainstream Medical Treatment
In 2003 alone, over 60 million Americans who experience esophageal or stomach pain, gas, belching, and bloating spent over $4 billion just for the acid-blocking prescription drug Prevacid, not to mention the money spent on its pharmaceutical cousins—Propulsid, Nexium, Pepcid, Prilosec, Protonix, Tagamet, Axid, and Zantac. Over-the-counter antacids such as Maalox, Tums, Rolaids, Alka Seltzer, and Mylanta are also commonly used to neutralize HCl.
Both patients and doctors are quick to assume that heartburn, indigestion, and gastro-esophageal reflux disease (GERD) are caused by excess stomach acid. This is likely resulting from their mutual desire for a quick fix, the widespread availability of drugs that block HCl production, and a lack of knowledge and appreciation by the medical community and the public alike for the health-promoting benefits of HCl in digestion and general health.
Because heartburn or burning stomach pain can be caused by either HCl deficiency or excess, many people being presumptively treated for excess HCl actually have a deficiency of HCl causing their symptoms. Treatment based on a presumption of excessive HCl can compromise long-term health as acid-blocking drugs do in fact decrease acid production, but in doing so also impair normal digestion. Do not stop taking acid-blocking drugs without physician supervision.
Heidelberg Gastric Analysis
Heidelberg Gastric Analysis is a non-invasive test that was developed at the University of Heidelberg in Germany in the late 1960s to measure stomach acidity. The test requires that a patient swallow a small capsule that contains a tiny transmitter which measures the acidity (pH) of the stomach and transmits its data to a radio telemetry receiver that hangs from a neck strap and rests on the patient’s upper abdominal area. The signal is transmitted to a computer for processing. After getting a baseline pH reading, the patient swallows a small amount of an alkaline solution of bicarbonate that challenges the stomach’s ability to properly re-acidify. Testing is well-tolerated and takes between 45 to 90 minutes.
A Holistic Medical Approach
In addition to Heidelberg Gastric Analysis, other testing that may suggest hypochlorhydria include a comprehensive digestive stool analysis to establish the presence of undigested food, Candida organisms, and imbalances in the normal gut bacteria; and laboratory testing for vitamin and mineral deficiencies and anemia.
Preservation or restoration of normal digestive function is the goal of an integrative medicine approach to hypochlorhydria. This includes avoiding the use of acid-blocking drugs without first establishing the presence of excess acid production. Medically supervised supplementation of HCl by capsule with meals may be recommended to replace missing or deficient HCl. Similarly, deficient minerals, vitamins (notably injectible vitamin B12), digestive enzymes, and “friendly” bacteria (probiotics) may be supplemented, in addition to dietary recommendations. Avoidance of drinking water or other liquids with meals is recommended to avoid diluting HCl.
Once properly diagnosed, hypochlorhydria can be successfully treated with approaches that restore optimal digestion and help protect an individual’s future health.