GERD and Hypochlorhydria

Many of my patients come to me with GERD and Hypochlorhydria. They also bring with them their list of medications. More often than not, on that list is a proton pump inhibitor. Their history will tell me that they often presented with the symptoms of heartburn (sometimes interpreted as chest pain), regurgitation, and nausea. Years of gas, bloating, and IBS led to the initial diagnosis but unfortunately, because the symptoms may come and go, there is often no further investigation and they are then given a prescription. This is a perfect example where many times we treat the symptoms but not the underlying condition.

The main reason people finally end up in my office, is because they simply can’t lose weight. They have tried everything -even just water -and they swear they still gain weight. Obviously, there is an underlying problem. Proper diet, exercise and lifestyle changes are keys to a healthier weight but at the same time let’s try to solve the root cause of the weight gain.

The Problem

GERD is the incompetence of the lower esophageal sphincter, which allows reflux of gastric contents into the esophagus, causing burning pain. Diagnosis is clinical, sometimes with endoscopy, with or without acid testing. Treatment involves lifestyle modification, acid suppression using proton pump inhibitors and sometimes surgical repair.
Hypochlorhydria arises when the stomach is unable to produce hydrochloric acid (stomach acid). The stomach requires an acid environment for several reasons:
• First, acid is required for the digestion of protein.
• Second, acid is required for the stomach to empty correctly, and failure to do so results in gastro-esophageal reflux disease (GERD). These are the same symptoms as seen above, hence one of the main reason why we see a misdiagnosed and inappropriate treatment. Symptoms may subside temporarily but not for long.
• Acid is required to sterilize the stomach and kill bacteria and yeast that may be ingested.
• And an acid environment is required for the absorption of certain micronutrients, in particular divalent and trivalent cat-ions such as calcium, magnesium, zinc, copper, iron, selenium, boron and so on.
As we age, our ability to produce stomach acid declines, but some people are simply not very good at producing stomach acid; sometimes because of pathology in the stomach (such as an allergic gastritis secondary to food intolerance), but sometimes for reasons unknown.

Symptoms of Hypochlorhydria

When any of the above problems go wrong, it can result in the following symptoms.

1. Wind, gas and bloating as foods are fermented instead of being digested. i.e. irritable bowel syndrome
2. Gastro-esophageal reflux disease (GERD)
3. A tendency to develop Candida
4. Iron deficiency or Anemia
5. B12 deficiency
6. A tendency to allergies. The reason for this is that if foods are poorly digested, then large antigenic molecules get into the lower gut, where if the immune system reacts against them, that can switch on an allergy.
7. Accelerated aging because of mal-absorptionof key nutrients and minerals in the gut.

Sound like anything you may be experiencing?

 

Possible Problems with Low Stomach Acid or Hypochlorhydria

There are many possible problems that could arise from hypochlorhydria

Failure to digest foods properly.

This will result in a general malabsorption of proteins. Indeed hypochlorhydria – as induced by antacids and H2 blockers and protein pump inhibitors – substantially increases one’s risk of osteoporosis because the body simply does not have the raw material to replace bone. Many degenerative conditions will be associated therefore with hypochlorhydria.

Failure to absorb trace elements.

Trace elements are essential for normal body functioning, if these are not present then the biochemistry of the body will go slow, organs will go slow, and this will accelerate the ageing process. Therefore, one would expect to see people getting diseases such as cancer, heart disease, and neuro-degenerative conditions before their time.

Failure to sterilize the stomach contents.

This will make individuals more susceptible to gut infections such as gastro-enteritis and possibly enteroviruses such as Epstein-Barr virus, Coxsackie virus, Echovirus, and so on.

Gastric acid is an essential part of normal defenses against disease. Gastric acid is also essential for getting rid of undesirable bacteria and yeast that appear in the diet. Particularly virulent strains, may also cause simple food poisoning. However, if there is an overgrowth of bacteria and yeast in the stomach, then foods will get fermented instead of being digested. This produces wind and gas resulting in bloating and alcohols which may or may not be useful to the body.

Increased risk of stomach cancer.

Having the wrong bacteria and yeast in the stomach will irritate the lining of the stomach and increase one’s risk of stomach cancer.

Mal-absorption of B12.

It is well known that the stomach must be acid in order to absorb B12. Indeed, using a proton pump inhibitor such as omeprazole [a drug used to reduce stomach acid production – trade names LosecR and PrilosecR – often prescribed for patients with heartburn (gastroesophageal reflux disease or GERD)] will reduce absorption of vitamin B12 to less than 1% of expected. Many people already suffer from borderline B12 deficiency – this is a difficult vitamin for the body to assimilate, but essential for normal biochemistry.

So before you take that little piece of paper, please investigate and allow the problem to be rectified and correct the root cause, not mask the symptoms.

Yours in Health,

Dr. Joann Osbourne

References:
1. Berenson A. “Where Has All the Prilosec Gone?” The New York Times, March 2, 2005.
2. Stiefel U, Jump RL, Donskey CJ. Suppression of gastric acid production by proton pump inhibitor treatment facilities colonization of the large intestine by vancomycin-resistant Enterococcus and Klebsiellapneumoniae in clindamycin-treated mice (Abstract B-1123). 46thInterscience Conference on Antimicrobial Agents and Chemotherapy. San Francisco, Sept. 27-30, 2006.
3. Dial S, Delaney JA, Barkun AN, Suissa S. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA, Dec. 21, 2005;294(23):2989-95.
4. Laheij RJ, et al. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA, Oct 27, 2004;292:1955-1960.
5. Yang Y, Metz DC, et al. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA, Dec. 27 2006;296:2947-2953.
6. Ruscin JM, Page RL, Valuck RJ. Vitamin B(12) deficiency associated with histamine(2)-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother, May 2002;36(5):812-6.
7. Valuck RJ, Ruscin JM. A case-control study on adverse effects: H2 blocker or proton pump inhibitor use and risk of vitamin B12 deficiency in older adults. J ClinEpidemiol, April 2004;57(4):422-8.
8. Wolters M, Strohle A, Hahn A. Cobalamin: a critical vitamin in the elderly. Prev Med, Dec. 2004;29(6):1256-66.
9. Zavros Y, Merchant JL, et al. Chronic gastritis in the hypocholorhydric gastrin-deficient mouse progress to adenocarcinoma. Oncogene, March 31;24:2354-2366.

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