Have you been struggling with acid reflux, heart burn, or indigestion? Do you take over the counter or prescription acid blockers (like tums, rolaids, prevacid, prilosec, zantac) to help combat your symptoms, only to find them returning soon after? There may be other imbalances in the stomach contributing to your symptoms!

 

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Brooke:
Hey there, you are listening to IWG radio, the place to be for all of your wellness needs. My name is Brooke and I am the Clinical Nutritionist at Integrative Wellness Group. I'm here with Dr. Nicole today to talk to you more about indigestion. Welcome Dr. Nicole, I'll have you give a little bit of a brief introduction on functional medicine.

Nicole:
Hey everyone. Functional medicine is an approach to using very specific lab analysis in order to get to the root cause of your symptoms. Then through the findings with the lab analysis, setting you up on a natural approach to resolve the core root issue of the symptoms that you are dealing with.

[00:01:00]
Brooke:
In a functional medicine perspective, talking about something like indigestion, why don't you talk about what might be happening in some of the associated symptoms with that?

Nicole:
[00:02:00]
I think indigestion is something that is synonymous with the other terms that we use like heartburn, reflux. Some conditions that people may have been diagnosed with could be GERD, which is gastroesophageal reflux disorder. Some people, as well, may have had a history of gastric ulcers as well as the possibility of Barrett's esophagus which usually comes later down the line with having an overabundance of acid for x amount of years. I think where the confusion comes into play is that most of us that experience these types of symptoms, if it's indigestion, heartburn or even if it's excessive burping, we automatically think we have an overproduction of stomach acid. That is one of the reasons why we are utilizing different types of acid blockers as medication or over the counters. What I actually find in my practice is that 95% of people that are complaining of either burping, indigestion, heartburn, they are usually having a low amount of stomach acid which is creating a lot of those symptoms. I think that is surprising to many people.

Brooke:
[00:03:00]
I would agree that most people think that, we are so branded that it's high stomach acid and when you get those symptoms, it almost feels like a burning sensation. I think that most people don't understand that there are a lot of reasons why, and you can explain maybe why the acid would deplete, but that the food is actually sitting there and actually causing that kind of fermentation. Why don't you explain that process a little bit more?

Nicole:
[00:04:00]
It's very similar to what you just said. The way to think about it is if you do have a lack of stomach acid, then you eat food and one of the first parts of the digestive tract that it goes to is going to be the stomach. Normally, you have appropriate amounts of acid that will break down your food and then move it through into the small intestine, but if you don't have enough stomach acid, then your food sits there and it almost starts to decompose the same way that trash does. I know that sounds really graphic and terrible, but if you think about it, if you leave trash in your garage and you obviously go out in the garage and you're like oh my gosh. It stinks, it smells. It's typically because the food is sitting there decomposing and there is a gas that is coming off creating the odor. If you have these different types of gases which are the byproduct of the food breaking down in the stomach, AKA where it's not supposed to break down, then that is is going to be something that will create that reflux type symptom and also can create burping. I think that is one of the big misconceptions is it's really not always about the high stomach acid, but it's more so about improper digestion of your food in the stomach.

Brooke:
What would cause this to happen?

Nicole:
[00:05:00]
Some of the lifestyle things that can really affect our stomach acid is chewing gum. What I mean by that is if you're someone who chews gum often, then anytime you start to chew, your stomach starts to produce more acid. Typically, it's because it thinks you're getting ready to digest a meal. The stomach is essentially prepping itself for food to enter. If you are chewing gum consistently and your stomach starts to produce acid and then it produces acid again and again and again, and no food enters the stomach, it's almost like fool me once, fool me twice, okay, you are not going to fool me again. The stomach just stops the acid production because of the lack of food entering the system. Chewing gum can actually have an adverse effect on your stomach acid and literally have your stomach stop producing acid.

[00:06:00]
Another thing that can happen is actually coffee. Coffee on an empty stomach. It's the same exact concept, if you drink coffee which is highly acidic on an empty stomach, then you're putting acid into the stomach. The stomach, therefore, will shut down its production of additional acid because if you add acid on top of acid, you're going to get an ulcer. Your stomach will start to downgrade its production of stomach acid due to consistently having coffee which is acidic on the empty stomach.

The last thing which is deemed healthy for many people is actually drinking alkaline water or ionized water, they are pretty much the same thing. Alkaline water is something that we have been introduced to because we say that having an alkaline environment in our body creates health. Yes, that is accurate in the blood, but if you are drinking alkaline water, you're alkalizing the one system in your body that should not be alkaline and that's your digestive tract. Your digestive tract 100% needs to be acidic, not only for you to break down food, but also for you to fight bacteria or other types of infections.

Brooke:
[00:07:00]
I think the last thing to mention there, too, is that like you said a lot of people think that it's overproduction of stomach acid and then we are introducing things like Tums and Prevacid and, yes, that's further lowering the stomach acid?

Nicole:
Yes.

Brooke:
Then if they are overusing that on top of it, then that could be another reason for the decrease in stomach acid.

Nicole:
[00:08:00]
Definitely. I know this can sound confusing if somebody is using these different types of over the counter PPI's which are proton and pump inhibitors or other types of acid blockers and they are mentioning that they are having some relief even despite the low stomach acid. You have to understand that these acid blockers are going to tone down the effect of some of the gases that the undigested food are creating. That's one of the reasons why you might have some immediate relief. Overall, they could be contributing to the problem getting worse. Even if you're not someone maybe experiencing so long to indigestion or discomfort, if you are someone who burps often, especially after your meals, you typically don't have adequate amounts of acid or adequate amounts of enzymes to break down your food. This is something that can set you up to get bacterial infections of your gastrointestinal system, especially the stomach.

Brooke:
Tell us more about some of those infections that might happen.

Nicole:
[00:09:00]
One of the other major things that I always consider when somebody comes to me and is telling me that they have had heartburn for many years or they've had chronic burping or they've even been diagnosed with GERD, I definitely always want to rule out the possibility of something called H. pylori. H. pylori is a bacterial infection of the stomach which is pretty contagious. It's pretty easy to get if you've known somebody who's had it or even if you shared a beverage with someone. It's definitely something again that is contagious. H. pylori is an infection that specifically happens in the stomach and this is something that can actually start to really alter your enzymes and your stomach acid.

In the beginning, a lot of times we will find that the stomach acid will be lower, but what can happen over the long-term is actually your stomach starts to overproduce the stomach acid. If you think about it, stomach acid protects us against bacteria so if you have a bacterial infection in the stomach already, your stomach will start to pump out a bunch of acid in order to kind of help to kill it. Then you could eventually develop an ulcer or a gastric ulcer, specifically, or even possibly what you'd call a duodenal ulcer. This could be a result of a long-standing infection of H. pylori in the stomach. Again it's your body's protective mechanism because it's trying to fight the infection, but it definitely can irritate your stomach lining.

[00:10:00]
Brooke:
What can people do at home to try to figure out if it's low or high stomach acid?

Nicole:
One of the things you can actually do at home is a beet test. If you have ever consumed beets, fresh beets specifically, not canned or pre-packaged beets. Beets usually will be broken down properly in the digestive tract if you have adequate amounts of stomach acid as well as enzymes. What can happen is if you do not have adequate amounts of stomach acid, if you consume beets, you'll actually find that your urine will turn a light pink, maybe like a light purple type color because essentially your body did not break down the betaine which was in the beets.

[00:11:00]
That's actually a really interesting test to do because you can actually see it within a few hours or even into the next day. If you do have discoloration of the urine, then that means you typically do not have adequate amounts of stomach acid.

Brooke:
Talking about clinical testing, which route would you go for that?

Nicole:
Clinical testing, the way that you're going to test for H. pylori to rule that in or out is you're going to want to do that typically through stool analysis. That's typically an add-on test when you do a stool analysis. You can add on checking for H. pylori. You can technically check for H. pylori in the blood as well. It's not always the most accurate marker so I always opt for stool first. Even looking at a routine blood test, if you look at the chloride levels on blood, that is typically going to be an indicator for how much is stomach acid is present. That's one of the things that I end up seeing is that the chloride levels are rather low in many people that are dealing with these different types of symptoms if it's burping, indigestion, reflux, heartburn at cetera.

[00:12:00]
Brooke:
If you do have someone present to you and H. pylori is present, actually let's talk about both ways. If someone has low stomach acid, what would we do in that scenario versus maybe an H. pylori infection and high stomach acid.

Nicole:
[00:13:00]
Yeah, they are definitely two different routes that you would want to go. Somebody who has low stomach acid it's a pretty straightforward fix. You're going to want to use betaine hydrochloric acid in order to improve that. You also need to take into consideration that somebody who has low stomach acid, chances are they don't have adequate amount of enzymes. When I say enzymes, just for lack of confusion, you have an enzyme to help you break down proteins, you have an enzyme to help you break down carbohydrates, you have an enzyme to help you break down fats. They are pretty much for every molecule of food. The enzymes travel through your entire digestive tract, but you do have enzymes in your stomach as well. Typically, I will opt for a supplement that is going to contain stomach enzymes in addition to the hydrochloric acid. Some people definitely opt for hydrochloric acid with pepsin which is a great option, but betaine hydrochloric acid is definitely something that I use quite often. That would be the route in the event somebody does have low stomach acid.

[00:14:00]
In the event that somebody truly does have high stomach acid, then you would actually want to use deglycerized licorice. That is something that will help to actually coat the stomach and tone down the overproduction of acid. That works really, really well, but I will say this, if you're somebody listening to this right now and you don't plan on getting the testing and you pretty much say, "No, I 100% have high stomach acid. I know that I do. I have all the symptoms," and you go out and you purchase the deglycerized licorice and you start to consume that, you're going to feel pretty terrible. Just be cautious. You can go to your primary care physician and have them run a CBC and metabolic panel and your chloride will be on that. You can get that information pretty easily before you jump in and decide to go and purchase supplements. I would definitely be more cautious with that.

Somebody who is truly dealing with H. pylori, that is actually going to be a whole protocol that is geared toward killing the infection. You're going to want to use stomach acid support, but you're also going to want to use different kinds of antimicrobial and antibacterial. Goldenseal is also a fantastic option for that. You need to definitely does it properly. Again, testing always helps with that. Those are some really good options in the event of H. pylori. It can be a persistent infection. Typically, you need to be working with a physician to get retested and make sure that you have completely eradicated it.

[00:15:00]
The other thing too, just as a at home way of testing yourself, is if you are someone who takes a shot of apple cider vinegar and you feel really good after doing that, then that typically is also an indicator that you have low stomach acid. Again, if you take the apple cider vinegar shot and you feel worse, than that is someone who typically has high stomach acid.

Brooke:
Apple cider vinegar is typically a pretty good way to, if someone doesn't want to necessarily do the betaine hydrochloric acid for the stomach, apple cider vinegar is something that can be used as an at-home way to help boost your stomach acid levels as well.

Nicole:
Definitely.

Brooke:
It's a good test. If you'd like, we would love to send you a follow up with some of those tips, trying the beet test or apple cider vinegar at home so you can feel free to opt in. We will speak to you next time.