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Dr. Kennedy, health healing medical medicineby Ron Kennedy, M.D.
(For an appointment
with Dr. Kennedy in
Santa Rosa, CA, write to nexus@sonic.net)

Hypochlorhydria

E-mail, hypochlorhydria, anti-aging, aging

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Why is it some people age faster, require more medical attention and die earlier in life than others? The medical answer has always been that it is because of "constitution," or in the most modern mythological jargon, "It's in your genes." All this is another way of saying "We don't know." (Medical jargon has a lot of ways of saying "We don't know.") I know. Let me tell you about it.

One branch of progressive medicine is nutritional medicine. There is no category of disease which cannot be helped by the nutritional approach. By the term "nutritional approach" I mean the use of oral and intravenous nutrients, as well as the institution of dietary changes. There is no such thing as a person who is ill from a degenerative disease process (breakdown of joints, sclerosis of arteries, cancer, etc.) who also has been optimally nourished his or her entire life. All degenerative disease has its origin in malnutrition.

"But, how can people in America be malnourished?" you may ask. Easily. Eat the typical American diet, and you become borderline nourished. Do worse than that, and malnutrition appears in the form of degenerative disease. Many people who eat a perfectly nourishing diet also are malnourished and end up with degenerative disease. How can that be?

If the proper food is eaten and the proper nutrient supplements taken, that is one thing. It is quite another for that food and those nutrients to be absorbed into the body. Just because something goes down your esophagus does not mean that it will make it to the cells of your body. First, it must penetrate the wall of your intestines. If it does not encounter the proper acid and enzymes, it will not digest and absorb properly, and you will become malnourished, making your body fertile ground for the development of infectious and degenerative diseases.

Normal digestion is a complex cascade of events beginning when food is placed in the mouth and ending with elimination about 24 hours later. Normal digestion requires thorough chewing, mixing of food with enzymes, efficient swallowing, followed by exposure to a large quantity of acid and enzyme in the stomach. About two hours later, the chyme (food in the process of digestion) is moved on to the small intestine where it is bathed in bile, bile salts and more enzymes. More absorption occurs, and the chyme is mixed with bacteria to aid in digestion. After being moved to the colon, water is reabsorbed, and vitamin E is manufactured by "friendly" bacteria.

Digestive disturbance can happen anywhere along the intestinal tract resulting in less than optimal digestion and a state of relative malnutrition. Many of these conditions are rare, and it is unlikely that you or your loved ones are suffering from them. It is possible, however, and if they are present, your doctor should be able to diagnose and treat them. While each disease is important, especially to the well-being of the person who has the disease, my purpose here is to alert you to a condition which is both common, frequently undiagnosed and usually untreated: hypochlorhydria.

Hypochlorhydria is the underproduction of hydrochloric acid by the stomach. Hydrochloric acid, or HCL as it is called, is responsible for two important functions: (1) it begins the breakdown of protein by simply frying it in acid, and (2) in the presence of food it activates an enzyme called "pepsin," which further breaks down protein.

For many years, hypochlorhydria was a condition doctors could only suspect but not diagnose — except with lab tests so difficult to administer, it was easier to rationalize not making the diagnosis and not treating the illness. This test involved shoving a tube down the esophagus and periodically suctioning out the stomach contents after a meal, so the acidity of those contents could be measured.

So, doctors rationalized a point of view that the disorder is not worth treating. Therefore, medical students were taught to ignore symptoms of hypochlorhydria, because the necessary test to make the diagnosis was more difficult for the patient than the disorder itself. Medical students do believe what their med school professors tell them, and this led to a generation of doctors unwilling to further examine the problem of hypochlorhydria.

However, that situation began to change in the late 1960s with the invention of the Heidelberg machine. This elegant (but expensive) device involves swallowing a capsule about the size of a vitamin capsule. This capsule is an acid-measuring radio telemetry device. It measures the acidity of the stomach and radios the results to an antenna which the patient wears like a large belt around the waist during this one- to two-hour test. While the telemetry capsule is in the stomach, we challenge the stomach's ability to make acid by having the subject swallow a teaspoon of water saturated with sodium bicarbonate. If the stomach is normal, we can see the acidity return to the stomach. If the stomach is unable to withstand five of these challenges, we know we are dealing with hypochlorhydria. The ability to diagnose hypochlorhydria is a wonderful advance in medicine, one which too few doctors are taking advantage of due to the party line that hypochlorhydria is not worth treating.

Many people who have too little stomach acid are being treated as if they have too much. The reason for this is that the symptoms are similar. Because ten to fifteen percent of the population is hypochlorhydric, there are many people out there who are being misdiagnosed and mistreated. A full fifty percent of people over age 60 are hypochlorhydric and, of all the patients coming to a doctor, up to fifty percent of these have underlying hypochlorhydria. The image of the overactive stomach is so common, many people are treating themselves with antacids without even bothering to consults their physicians.

The view that the action of the stomach on digestion is so inconsequential as not to merit proper and concise diagnosis and treatment is, in my view, indefensible. Why would nature have given us the ability to concentrate HCL in the stomach one million times more than the surrounding tissues, if it were not needed?

Stomach acid serves many important functions, not only in digestion, but also in keeping the body free from disease. Many bacteria enter the body with food. Some of them are not friendly to human life. In a normal stomach, these bacteria are doused with acid and die. In a person with hypochlorhydria, these bacteria are escorted into the small intestine along with a generous food supply. It has been shown that people with hypochlorhydria have more than their share of infections. The ever present yeast organism makes its entrance via the mouth. Many people with the so-called "yeast syndrome" are unable to get rid of their yeast because the organism continues to reinfect the body through the mouth.

Frequently, stool analyses of people with hypochlorhydria reveal the presence of undigested protein fibers. While able to digest enough protein to live using their own pancreatic enzymes or enzyme supplements, these people are not getting the full benefit of the food they eat. The final result is that these people do not feel as good as they could and have no idea why.

Certain symptoms of hypochlorhydria make life very unpleasant for a person as well as for other people around. The collection of gas in the stomach results in frequent burping, a troublesome and embarrassing symptom. Unexplained bloating, belching and "heartburn" frequently are diagnosed as symptoms of hyperacidity and wrongly treated with antacids, when what is really going on is insufficient acid production. The resulting imbalanced bacterial flora further down the digestive tract produces a lot of hydrogen sulfide gas, and this does nothing for your social standing.

Some people have done all they can think of doing for their health: vitamins, exercise, etc., and still do not feel right due to the poor nutritional status of unrecognized hypochlorhydria, often combined with an underactive or overactive production of enzymes by the pancreas. See pages 178-192.

A voracious appetite may be related to hypochlorhydria simply because the person is not getting full nutritional value from food eaten. The body tries to solve this by demanding more food. "I am hungry all the time" should ring the hypochlorhydria bell.

The "big belly' is a common sight on the streets of America. In most cases, this is contributed to by hypochlorhydria and a relative absence of digestive enzymes, which should be derived from raw food. This combination of circumstances results in excessive eating and stasis of food in the colon. The excessive eating occurs because incomplete digestion causes a condition of undernourishment and hunger. When incompletely digested food reaches the colon, the colon reacts by slowing down, causing chronic congestion of food in the colon.

After being stretched like this for a few years, the colon can hold several gallons of food. Many people are not "fat," nevertheless, their big bellies hang on their bodies like giant water balloons, except it is not water.

Some people with hypochlorhydria report that food seems to sit in the stomach far too long after a meal. Others say they can eat only a small amount of food before feeling full. Still others are constipated while others have diarrhea. Many have no symptoms referable to the digestive tract.

That is not to say that they have no symptoms, however, because the number of non-intestinal disorders which are associated with hypochlorhydria is truly astounding. Because these diseases can be helped by nutritional means, it is reasonable to consider them nutritional in origin. Here is a list of those diseases associated with hypochlorhydria:

Allergies

Chronic fatigue

Autoimmune Diseases   

Weak nails

Thyroid disorders

Dry skin

Diabetes mellitus

Poor night vision

Gallbladder disease

Hypoglycemia

Asthma

Weak Adrenals

Vitiligo

Rheumatic arthritis

Acne rosacea

Lupus erythematosis

Chronic hepatitis

 
Given the commonness of the problem, I believe anyone with any of the symptoms or conditions above should have a Heidelberg test or a test trial on hydrochloric acid supplementation. While the Heidelberg test is rather expensive (at present $175), it more than pays for itself when the proper diagnosis is made.

Alternatively, under your doctor's supervision, you may elect to take Betaine HCL with your meals. If you are able to do this without a burning sensation, and if your symptoms are alleviated, this is sufficient, in my opinion, to confirm a diagnosis of hypochlorhydria.

If the diagnosis is not hypochlorhydria, the Heidelberg test will pick up the problem if it exists in the stomach or first part of the small intestine. Hyperacidity, the "Dumping Syndrome" (in which food passes directly from the stomach into the small intestine), achlorhydria (the complete absence of stomach acid), gastritis, gastric ulcer and pyloric insufficiency are all easily seen on the graph drawn by the Heidelberg machine. Even if the test turns out to be perfectly normal, this information can be invaluable, because your doctor does not need to continue to look at your digestive tract for the cause of your problems.

The standard medical approach to hypochlorhydria has been to ignore it and say that it makes no difference. This movement in medicine was partially based on studies using HCL replacement alone. In fact, there is more missing than hydrochloric acid. The same cells (the parietal cells) which make HCL also make pepsinogen, which is converted to pepsin in an acid environment. Therefore, pepsin usually is also deficient and must be replaced for best results. Most Betaine HCL preparations come with 30 or 40 mg. pepsin.

An item called "intrinsic factor" may be in short supply, because it also is made by the parietal cells which produce acid and pepsinogen. Intrinsic factor makes the absorption of vitamin B12 possible, and without it B12 deficiency sets in. This disease is called pernicious anemia.

The hypochlorhydric stomach often makes insufficient amounts of intrinsic factor and, therefore, it is necessary to give a series of vitamin B12 injections to get the best result from treatment of hypochlorhydria.

The question is sometimes asked: what is the root cause of hypochlorhydria, and what can we do to restore function naturally so the stomach resumes its function of manufacturing acid? There probably is a root cause, although we are unaware of what it may be. I suspect it has something to do with an as yet unrecognized nutritional deficiency, although I have nothing to back up this hunch.

There also is the possibility that the parietal cells of the stomach simply die off before the rest of the organism. Perhaps each individual has certain cell lines which are destined to die before the entire organism bites the dust. It also may be that industrial pollution and the pollution of our food supply with pesticides, herbicides and preservatives contributes to the early demise of parietal cells.

Treatment of Hypochlorhydria

We do not yet know the true cause of hypochlorhydria. When we find it out, we may be unable to cure it, but at least we can now treat the condition and return the patient to normal functioning.

Once the diagnosis is certain, one of two items can be used: betaine hydrochloride or glutamic acid hydrochloride. These "carrier molecules" make it possible to introduce the HCL as a powder in a capsule and thus avoid damage to your teeth, which occurs with the liquid form of HCL. These preparations should always contain pepsin for best results.

The solid tablet form of HCL is to be avoided because it is not as effective as the powdered form. When you put the HCL into your stomach with a meal you want it to work then, not later when the tablet has finally dissolved.

The amount of HCL needed can vary from 30 to 100 grains. The largest capsules are ten grains, so this means three to ten caps with each meal. The number per meal can vary based on the quantity and type of food you are eating, but no exact guidelines can be stated. You should start with one cap with a meal, and if this is tolerated, build up with each successive normal meal (whatever is "normal" for you) until you experience a burning sensation. One cap less than that dose which produces a burning sensation is your proper dose for a normal meal. The dosages for smaller or larger meals are adjusted accordingly.

These may seem like large doses; however, they represent considerably less acid than a normally functioning stomach can make. I recommend no more than this, because this amount seems to work. I believe in using the lowest dose of anything which works.

The lab tests which will reveal the benefit of HCL supplementation are: (1) stool analysis to demonstrate complete protein digestion, (2) a blood count to demonstrate correction of pernicious anemia or a previously iron-resistant form of anemia (due to poor iron absorption) and (3) x-rays to demonstrate recalcification of certain types of osteoporosis caused by poor calcium absorption in turn due to low stomach acid.

In addition, a few weeks of supplementary vitamin B12 intramuscular injections twice each week usually produces marked improvement in well-being and a clearing of several symptoms. The B12 is given in combination with folate, so that folate deficiency is not masked and left untreated by the injections. B12 and folate together usually result in more sound sleep, more energy and less anxiety.

As you might suspect, B12 injections are out of vogue with the medical establishment because of the fact that a seven year supply of B12 can be stored in the liver. The fact that it can be stored does not mean that it is stored in this quantity in every individual, however. Even if B12 is stored in these quantities, this does not guarantee availability when needed in larger-than-usual quantities.

While it certainly is an inconvenience to supplement stomach acid with each meal for a lifetime it may be less inconvenient than the alternatives. It is well-known that hypochlorhydria is associated with increased risk of stomach cancer, and this may be due to the conversion of nitrites into cancer-inducing nitrosamines in an abnormally alkaline stomach. Also, intestinal overgrowth of bacteria and the incidence of parasitic infections is increased when stomach acid is low. Risk of cancer, risk of parasites, expected bacterial overgrowth and remember the always-present yeast organism, ever ready to become a problem — all adds up to a lot more inconvenience than popping a few betaine HCL caps with each meal.

See common digestive disorders and digestive insufficiency.

Sources
  • Wright JV Dr. Wright's Guide To Healing Nutrition Keats Publishing Inc., New Canaan Connecticut;1990:31-41. ISBN 0-87983-530-3.
  • Hartfall SJ Achlorhydria: a review of 336 cases. Guy's Hospital Report, vol. 82;1932:13-39.
  • Oliver TH, Wilkinson JF Critical review achlorhydria Quarterly Journal of Medicine, vol. 2;1933: 431-455.
  • Schiff L, Tahl T The effects of dessicated hog's stomach in achlorhydria Amer J Diges Dis vol. 1;1934-35:543-548.
  • Williams RH The Adrenals in Textbook of Endocrinology, 5th ed., WB Saunders;1974:271.
  • Dotevall G, Walan A Gastric secretion of acid and intrinsic factor in patients with hyper- and hypothyroidism Acta Med Scan, vol. 186;1969:529-533.
  • Matthews DM, linnell JC Vitamin B12: an area of darkness Brit Med Jour, Sept. 1, 1979:533-535.
  • Jacobs A, Rhodes J, Eakins JD Gastric factors influencing iron absorption in anemic patients Scan Jour Haematology, vol. 4, 1967:105-110.
  • Gillespie M, Hypochlorhydria in asthma with special reference to the age incidence Quar Jour Med, vol. 4;1935:397-405.
  • Ruddell WSJ et.al. Gastric juice nitrite Lancet, Nov. 13;1976: 1037-1039.
  • Rabinowitch IM Achlorhydria and its clinical significance in diabetes mellitus Amer Jour of Diges Dis, Sept. 1949:322-332.
  • Gianelli RA Broitman SA Zamcheck N Influence of gastric acidity on bacterial, and parasitic enteric infections Ann of Int Med, vol. 78;1973:271-276.
  • DeWitte TJ et.al. Hypochlorhydria and Hypergastrinemia in rheumatoid arthritis Ann of the Rheu Dis, vol. 38;1979:14-17.
  • Ryel JA et.al. Gastric analysis in acne rosacea Lancet, Dec. 11, 1920:1195-1196.

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The information in this article is not meant to be medical advice.
Treatment for a medical condition should come at the recommendation of your personal physician.

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