Gluten Free Works: TREATMENT GUIDE Get well and stay healthy living gluten free
Page Contents
What Is Low Stomach Acid Production?
Low stomach acid production is a common disorder in celiac disease and dermatitis herpetiformis that is characterized by lack of sufficient hydrochloric acid needed 1) to properly digest food, which results in malnutrition and subsequent nutritional deficiencies, and 2) to destroy swallowed bacteria and other microbes, which may allow infections to develop.
It is also common in the general population, as well, affecting 50% of people age 60 years and about 80% by age 85 years. Nevertheless, low stomach acid is not generally looked for as a cause of acute and chronic disorders that rob health with far-reaching effects.
The stomach digests incoming food into a liquid state, thereby releasing nutrients so they can be absorbed by the small intestine. Powerful stomach muscles churn food and mix it with gastric juice, dissolving and breaking it down.
Gastric juice is produced by gastric glands located in the stomach lining. These numerous, microscopic glands produce about 3 liters of juice a day. Gastric juice is composed of a high concentration of hydrochloric acid and the enzymes, pepsin and gastric lipase.
- Hydrochloric acid is secreted by parietal cells on the margin of the gastric glands. This powerful acid keeps the stomach at a pH of 1.5 to 3.5, meaning very acidic level, to dissolve food and kill most organisms that are swallowed with food.
In chemistry, the pH scale measures acid to base levels of a substance that ranges between 0 (most acidic) and 14 (most base) with 7 being neutral (neither acid nor base). The pH scale is logarithmic and as a result, each whole pH value below 7 is ten times more acidic than the next higher value. For example, pH 4 is ten times more acidic than pH 5 and 100 times (10 times 10) more acidic than pH 6. Pure water is neutral.1
1. Mineral digestion. Hydrochloric acid dissolves minerals such as potassium, iron, calcium, zinc, copper and magnesium out of food and gives them a positive or negative charge. Unless minerals get charged, they cannot be absorbed into the body but instead pass out with stool.
2. Protein digestion. Hydrochloric acid is necessary to break down proteins acting together with the enzyme pepsin.
- Pepsin digests protein in the acid environment (pH of 1.5 to 2) provided by hydrochloric acid. So we see that low acid production makes high protein foods like meat, eggs and milk hard to digest.
- Gastric lipase begins the digestion of fats.
Q: What problems develop when food is poorly digested because of low stomach acid production?
A: Poorly digested food in the stomach results in delayed digestion. Delayed digestion means that food remains in the stomach longer than the time normally required to dissolve it into a liquid mass, called chyme. Only chyme can pass out of the stomach and enter the small intestine for further action.
Delayed digestion causes symptoms of dyspepsia such as the discomfort of feeling full before finishing your meal (early fullness), feeling full too long after eating, pain, and gas build-up.
Delayed digestion can result in reflux, or back-up, of stomach contents into the esophagus.
When stomach contents continually back up into the esophagus, erosive esophagitis or reflux esophagitis result which is the most common disorder of the esophagus.
Reflux esophagitis does not depend on high or low stomach acid but rather on the ability of the muscular LES (lower esophageal sphincter) to prevent stomach contents from going back up the esophagus. That said, low stomach acid weakens the LES, allowing reflux.
Here’s the LES anatomy: The esophagus is a muscular tube that transports swallowed substances to the stomach. It begins at the cricoid cartilage (Adam’s apple) as a continuation of the throat and ends at the LES where it joins the stomach. This sphincter is a thick bundle of circular muscles.
Here’s the LES physiology: The LES functions like a circular band that quickly opens to let food pass from the esophagus into the stomach and closes after food passes in order to prevent its going back up the esophagus while powerful stomach muscles churn food to dismantle it and acid dissolves it.
Most importantly, the LES reacts to hydrochloric acid levels below 2.5 pH by remaining tightly closed to protect the normally alkaline tissues of the esophagus (mucosa) having a neutral pH of 7. Esophageal tissues are damaged by acid levels below 4.2
Here’s the LES problem: The LES becomes fatigued when stomach muscles work too long trying to form chyme because inadequate stomach acid is not doing its part to dissolve food. Also, the LES may be weak with low muscle tone from deficiencies of magnesium, calcium or potassium that are required for normal muscle function. These deficiencies result from low stomach acid production.
Meanwhile the esophagus becomes inflamed and damaged brought about by the caustic action of acid and pepsin in gastric juice and, in severe cases, also bile salts, that back upwards through a weak LES. Gastric acid combined with pepsin or bile salts seems to be more harmful to the esophageal tissues than gastric acid alone.3
Pepsin is a stomach enzyme meant to digest food protein. Pepsin is itself non-acidic BUT becomes active when the pH is below 4. Therefore, if pepsin abnormally splashes onto sore tissues of the esophagus by reflux, it will act to break down their exposed protein.
Damage starts at the surface of tough cells that line the esophagus, called squamous epithelium, and progresses into underlying tissues. One of the primary functions of the epithelium is to protect underlying tissues from mechanical and chemical damage by acting as a barrier. When the epithelium fails to protect the underlying tissue from reflux, it leads to erosions, esophagitis, and may lead to Barrett’s esophagus.3
Barrett’s esophagus and esophageal small cell cancer are severe complications of GERD that can be fatal.
How Is Stomach Acid Tested?
Methods for measuring gastric acid include both invasive and non-invasive techniques.
- Invasive tests include the conventional gastric acid aspiration tests, gastric pH measurement techniques and endoscopic methods.
- Non-invasive methods use urinary analysis, breath analysis, serum pepsinogens assay (blood test), scintigraphic techniques, impedance tomography and alkaline tide for measurement of gastric acid.
- Here’s a home test: drink lemon juice (pH of 2) in water (a teaspoon in 2 ounces water) and see if you burp. If your stomach is more alkaline than the acid you take, gas is formed and you burp. Rice vinegar and apple cider vinegar are less acidic with a pH range of 3.5 to 4.5.
Acid-lowering drug advertisements would like us to think that ONLY excessive stomach acid causes heartburn and gastrointestinal reflux disease (GERD) because they make a great deal of money in selling their pills…Consider that two antacid pills, Nexium® and Prevacid,® totaled $7,523,382,000 in sales for 2009 according to Drugs.com.
Fact: Weakly acidic reflux damages the esophagus4 as well as excessively acid reflux. There you have it…ANY acidic reflux damages the esophagus.
Fact: Low stomach acid is a MORE common cause of heartburn and gastrointestinal reflux disease (GERD) than excessive acid production.
- These over the counter drugs do not cure heartburn or acid reflux. They only mask symptoms while interfering with your ability to produce hydrochloric acid.
- These drugs are meant for short term use. Continuing use of these potent drugs will impair your digestion which in turn increases your risk of developing nutritional deficiencies and subsequent health problems.
- These drugs can cause the following deficiencies: Vitamin B12, vitamin A, all minerals, and protein. For example, a systematic review and meta-analysis of the literature by W. Cheungpasitporn demonstrates a statistically significant increased risk of hypomagnesemia (magnesium deficiency) in patients with PPI use.
- These drugs can cause serious and/or life threatening health conditions. PPIs when used for more than a month are linked to premature vascular aging, dementia, heart attack, and renal disease.
What Is Low Stomach Acid In Celiac Disease and/or Gluten Sensitivity?
- Relationship between low stomach acid and celiac disease. Low stomach acid is an atypical symptom of celiac disease.
- Relationship between low stomach acid and dermatitis herpetiformis. A study investigating gastric acid secretion in 116 subjects with dermatitis herpetiformis found that 41% had low stomach acid and 26% were achlorhydric (no acid). Of those older than 50 years, 47% were achlorhydric. When compared to subjects with celiac disease, the frequency of achlorhydria was significantly higher in those with dermatitis herpetiformis than in those with celiac disease. There was no correlation between achlorhydria and small intestinal villous atrophy (damage). This means that you can lose the ability to produce acid whether you have minimal or severe intestinal damage.
- Relationship between low stomach acid and gluten. Research shows that a gluten free diet significantly decreased the relapse rate of GERD symptoms suggesting that celiac disease may represent a risk factor for the development of reflux esophagitis.5
- Relationship between low stomach acid and gluten free diet. A study investigating the prevalence of GERD symptoms at diagnosis and the impact of the gluten-free diet found that GERD symptoms are common in classically symptomatic untreated celiac disease patients and that the gluten free diet is associated with a rapid and persistent improvement in reflux symptoms that resembles the healthy population. At baseline, 30.1% of celiac disease patients had moderate to severe GERD (score more than 3) compared with 5.7% of controls. Moderate to severe symptoms were significantly associated with the classical clinical presentation of celiac disease (35.0%) compared with atypical/silent cases (15.2%). A rapid improvement was evidenced at 3 months after initial treatment with a gluten free diet with reflux scores comparable to healthy controls from this time point onward.6
How Prevalent is Low Stomach Acid In Celiac Disease and/or Gluten Sensitivity?
- Celiac patients have a high prevalence of reflux esophagitis. Retrospective study shows 19% in patients undergoing endoscopy for biopsy.7
- At diagnosis, celiac patients had a significantly higher reflux symptom mean score than healthy controls: 30.1% of celiac disease patients had moderate to severe GERD (score >3) compared with 5.7% of controls. Moderate to severe symptoms were significantly associated with the classical clinical presentation of celiac disease (35.0%) compared with atypical/silent cases (15.2%).6
- Of 212 patients undergoing upper endoscopy for dyspepsia, 3.3% of patients showed histopathological changes typical of celiac disease on duodenal biopsy. 8.5% of these patients had gastric reflux.8
What Are The Symptoms Of Low Stomach Acid?
Low stomach acid is marked by these digestive symptoms:
White Nails Belonging to Claire Were Opaque Before Treatment and Now Improved Over Past 2 Weeks.
- Abnormal gut flora (microbe population).
- Bad breath.
- Chronic candida (yeast) infections.
- Chronic H. pylori bacterial infection.
- Chronic intestinal parasites.
- Constipation.
- Diarrhea with undigested food in stool.
- Discomfort from gas buildup in the stomach and/or reflux.
- Feeling uncomfortable with bloating or feeling sick after eating.
- Food allergies.
- Indigestion.
- Itching around the rectum.
- Nausea after taking supplements.
- Poor digestion causing discomfort of fullness because food stays in the stomach too long after eating.
Other telltale symptoms include:
- Acne.
- Anemia.
- Apathy.
- Dilated blood vessels in the cheeks and nose.
- Eczema.
- Fatigue.
- Fingernails that are weak, peel, brittle or have ridges.
- Hair that is thin, brittle, or weak.
- Low resistance to infection.
- Low plasma proteins.
- Muscle wasting (loss).
- Premature aging.
- Osteopenia/osteoporosis.
- Skin that is dry and/or weak.
- White nails showing protein deficiency due to maldigestion.
- With accompanying niacin (vitamin B3) deficiency, these additional digestive symptoms may occur:
- Abdominal discomfort and distention (bloating).
- Burning of mouth, throat and esophagus.
- Distorted taste.
- Dysphagia: Difficulty swallowing.
- Loss of appetite.
- Weakness.
Later later digestive symptoms of niacin deficiencies include:
- Nausea.
- Vomiting.
- Diarrhea.
- Note: For a complete list of other symptoms, please see the post on niacin deficiency.
- With accompanying vitamin A deficiency, these additional digestive symptoms may occur:
- Dry mouth.
- Low mucous production in the digestive tract.
- Low stomach acid.
- Note: For a complete list of other symptoms, please see the post on vitamin A deficiency.
- With accompanying vitamin B12 deficiency, these additional digestive symptoms may occur:
- Altered bowel motility (peristalsis), causing intermittent diarrhea and constipation.
- Beefy red, smooth tongue with burning.
- Distorted taste.
- Low stomach acid.
- Poor intestinal function.
- Poorly localized abdominal pain.
- Note: For a complete list of other symptoms, please see the post on vitamin B12 deficiency.
- With accompanying iron deficiency, these additional digestive symptoms may occur:
- Increased susceptibility to bacterial infection of the stomach such as H. Pylori.
- Dysphagia: Difficulty swallowing.
- Loss of appetite.
- Pale, smooth, and sore tongue.
- Note: For a complete list of other symptoms, please see the post on iron deficiency.
- With accompanying calcium deficiency, these additional digestive symptoms may occur:
- Changes in saliva composition resulting in becoming too acidic.
- Defective tooth enamel.
- Dental caries (cavities).
- Note: For a complete list of other symptoms, please see the post on calcium deficiency.
- With accompanying magnesium deficiency, these additional digestive symptoms may occur:
- Bruxism (teeth grinding/jaw clenching.)
- Constipation.
- Nausea.
- Reduced bone density of the jaw which affects the health of teeth and the ability to chew food properly.
- Reduced availability of ATP (adenosine triphosphate) for the pumping of stomach acid.
- Note: For a complete list of other symptoms, please see the post on magnesium deficiency.
- With accompanying potassium deficiency, these additional digestive symptoms may occur:
- Reduced bone density of the jaw which affects the health of teeth and the ability to chew food properly.
- Thirst.
- Vomiting.
- For a complete list of other symptoms, please see the post on potassium deficiency.
- With accompanying copper deficiency, these additional digestive symptoms may occur:
- Diarrhea.
- Reduced bone density of the jaw which affects the health of teeth and the ability to chew food properly.
- Note: For a complete list of other symptoms, please see the post on copper deficiency.
- With accompanying phosphorus deficiency, these additional digestive symptoms may occur:
- In children, imperfect bone and teeth development.
- Loss of appetite.
- Reduced bone density of the jaw which affects the health of teeth and the ability to chew food properly.
- Weight Loss.
- Note: For a complete list of other symptoms, please see the post on phosphorus deficiency.
- With accompanying selenium deficiency, these additional digestive symptoms may occur:
- Promotes inflammatory conditions.
- Lowered resistance to infection that may invade the stomach such as H.pylori or candida albicans.
- Reduced bone density of the jaw which affects the health of teeth and the ability to chew food properly.
- Note: For a complete list of other symptoms, please see the post on selenium deficiency.
- With accompanying zinc deficiency, these additional digestive symptoms may occur:
- Impaired immune response to infection that may invade the stomach such as H.pylori or candida albicans.
- Impaired taste and smell.
- Loss of appetite.
- Disturbed zinc metabolism results in vitamin A deficiency.
- Note: For a complete list of other symptoms, please see the post on zinc deficiency.
- With accompanying reflux these additional symptoms may occur; however, reflux can occur without symptoms:
- Chest pain that may resemble angina in half of patients.
- Fullness under breastbone.
- Heartburn (burning sensation behind the breastbone).
- Regurgitation of bitter tasting fluid.
How Does Low Stomach Acid Develop In Celiac Disease?
- In active celiac disease, low stomach acid results from chronic gluten exposure that inflames and damages the ability of the stomach to provide adequate hydrochloric acid. Two conditions alone or combined may result:
- Loss of gastric cells that produce hydrochloric acid. Parietal cells in gastric glands secrete hydrochloric acid to chemically dissolve foodstuffs. The molecules needed to make hydrochloric acid originally come from the bloodstream. Within parietal cells specialized cells called proton pumps actually pump hydrogen ions (H+) into the hollow of the stomach along with chloride ions (CL-), making hydrochloric acid (HCL). Low number of acid producing cells means low acid production.
- Lack of ATP (adenosine triphosphate). The gastric parietal cells need quite a bit of energy from this enzyme, which may be inadequate in active celiac disease, to pump hydrogen ions from the inside of the parietal cell into the lumen of the stomach. Here we need to look at the negative impact of magnesium deficiency on ATP availability. A major function of magnesium is to stabilize the structure ATP within cells for the production of energy.
- Loss of hydrogen ions due to inflammation of the stomach lining. Hydrogen ions (electrically charged atoms) tend to diffuse back into the bloodstream but are normally prevented during digestion by tight junctions that exist between cells that line the stomach. However, if the stomach lining becomes inflamed, the ability of tight junctions to keep hydrogen ions from leaking back into the bloodstream is impaired. Hence the loss of hydrogen ions needed to dissolve food.
- Nutritional deficiencies impair the health of stomach cells. Deficiencies that result as a consequence of poor digestion due to low stomach acid in turn perpetuate this condition unless corrected. These include vitamin A, vitamin B12, and niacin. For example, vitamin A is required for the development and maintenance of cells which line the body so that deficiency results in poor regeneration of mucous membranes of organs of the digestive tract such as the stomach. Please see these posts for further explanation: vitamin A, vitamin B12, and niacin.
Does Low Stomach Acid Respond To Gluten Free Diet?
Yes.
In relationship to GERD symptoms, gluten free diet significantly decreases the relapse rate.7
The gluten free diet is associated with a rapid and persistent improvement in reflux symptoms that resembles the healthy population. A rapid improvement was evidenced at 3 months after initial treatment with a gluten free diet with reflux scores comparable to healthy controls from this time point onward.9
6 Steps To Improve Low Stomach Acid In Celiac Disease and/or Gluten Sensitivity:
- 1Remove the Trigger. Maintain a Strict Gluten Free Diet:
- Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
- A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
- Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.
Self-Treatment of Low Stomach Acid (hypochlorhydria):
Here are 8 approaches you can take on your own:
1. Eat smaller meals to reduce the need for stomach acid. You can make up the difference for your required daily amount of protein by adding snacks between meals that have protein such as 4 ounces yogurt, one egg, a tablespoon of nut butter, hummus, or an ounce of cheese. For sleep sake, it is best not to eat protein within 2 hours of bedtime.
2. Chew food slowly and thoroughly before swallowing to stimulate acid production and make it easier for your gastric acid to act on your food. Missing teeth? Use a hand held blender to do the job.
3. To pump more gastric acid, incorporate food sources of magnesium such as green, leafy vegetables (especially parsley and dandelion), seeds, nuts and fish. Add a magnesium supplement if indicated.
4. To help your gastric acid get the job done, incorporate foods with acid into your meals. Examples:
Vinegars. Unpasteurized apple cider, rice, distilled (comes from apples) and wine (balsamic) vinegar can be drizzled on foods and used in sauces or to make foods like cabbage slaw. Gluten-free condiments containing white vinegar (NOT distilled white vinegar which is made from wheat) such as pickles, olives, ketchup, and mustard can accompany sandwiches to improve digestion.
Fruit. Squeeze a slice of lemon into your drinking water with your meal or drink fruit juice. If fruit or juice is unavailable, take a high dose ascorbic acid supplement to provide citric acid with meals for better absorption of minerals. Enjoy an orange or other acidic fruit after the meal instead of a calorie laden, hard to digest dessert. Pineapple is yes but also tops for digesting protein thanks to its enzyme bromelain!
5. Do not drink coffee or eat chocolate within 1 hour of meals because they weaken the LES sphincter which subjects you to reflux.
6. Try a hydrochloride supplement, with or without betaine, to improve protein digestion. This is available in capsules, which need to be taken with food and the dose adjusted according to the response.
7. Relax after eating. Socialize, read the paper, or clean up slowly but do not exercise or do hard work right after eating. Allow your stomach to use the energy it needs to produce acid.
8. Get checked for a possible infection such as helicobacter pylori infection if you are prone to iron deficiency or candida if you have bloating or a white tongue. Please see these posts.
Correct Your Individual Nutritional Needs.
- Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
- Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.
Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the absorbing cells that make up the surface lining of your small intestine are better able to function.
- Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
- Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.10
- The intestinal lining may take up to a year to heal.
- 2 Reduce Inflammation. Foods to Eat and Foods Not to Eat:
Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).
- Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.11
- Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
- Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.11
- Bad Fats. Includes deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.11.
- Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.11
- Refined Sugars. Includes white sugar, corn fructose and high fructose corn syrup.
- Hot Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.11
- Alcohol and Caffeine. Relax the lower esophageal sphincter and disrupt intestinal permeability promoting leaky gut.11 Do not consume within 1 hour of meals.
- Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
- Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
- High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
- Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
- Omega-3 Fatty Acids. VERY IMPORTANT for low stomach acid to cut inflammation and balance opposing omega-6 fatty acids and bad fats. Fish sources (EPA and DHA) includes tuna, salmon, cod, and others. Plants sources (alpha-linolenic acid) include flax, chia seeds, walnuts, canola oil, and others.
- Probiotics. VERY IMPORTANT for low stomach acid to cure the chronic gastritis and help the stomach to produce acid normally as wells as to correct gut flora (microbe population). Probiotics supply normal microbes needed for the digestive system and health of the body. Includes fermented foods such as: yogurt, kefir, and unpasteurized apple cider vinegar and rice vinegar.
- Prebiotics/ High Fiber Foods. Food with fiber keeps our population of colonic microbes healthy and pushes food through the digestive tract.
- Protective Herbs and Spices. See below #6 for examples. Parsley is especially helpful for low stomach acid. Add paesley to food or simply chew some fresh leaves which also freshen the breath.
- 3 Information Sheet You Can Take to Your Doctor or Other Health Professional:
- 4Manage Your Medications Safely:
Certain prescription drugs that are commonly prescribed for GERD deplete nutrients. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.
This is not a complete listing.
ANTACIDS / ULCER MEDICATIONS –
|
DEPLETE THESE NURIENTS –
|
- 5Nutritional Supplements To Help Correct Deficiencies:
The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.
- L-glutamine 250 to 500 mg just after eating has been shown to heal the esophagus.12 This is a safe dose, but always check with your doctor to avoid interactions with medications or if you are on a low protein diet since this is an amino acid. L-glutamine is a natural fuel for the cells that line the intestines.
- Multivitamin/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
- Probiotics that include acidophilus and lactobacillus strains.
- Milk thistle is VERY effective to improve stomach acid, repair the gut and help the liver.
Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.
- 6Manage Natural Remedies:
Carminatives are plant sources that tone muscle and improve peristalsis, and thus aid in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort. However, some carminitives relax the lower esophageal sphincter thus aggravating GERD.
DO NOT use these carminitives: fennel, lemon balm, peppermint and spearmint. The same goes for cigarette smoke, alcohol, high fat foods, mints, chocolate, onions, and caffeine.
- Raspberry.
- Carrot is also a cleansing digestive tonic.
- Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
- Redbeets stimulate and improve digestion and are easily digested.
- Cabbage stimulates and improves digestion and is also a liver decongestant. Proven to help GERD.
- Lettuce stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
- Dandelion is a digestive and liver tonic, bile stimulant, and mild laxative. VERY good to help low stomach acid.
Carminative Herb Remedies:
- Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa. Drink as tea or use in cooking. Grow it as a small shrub in your garden or in a pot…lives for many years!
- Parsley relieves colic, gas and indigestion. VERY good to help low stomach acid. Also binds toxins for excretion.
- Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
- Thyme is a soothing remedy useful for stimulating digestion of rich, fatty foods.
- Calendula is also an astringent and anti-inflammatory that makes it an effective remedy for GERD. Use as a tea. (Steep a teaspon of flowers in a cup of hot water for 10 minutes.)
Carminative Spice Remedies:
- Cloves are antispasmodic.
- Nutmeg is also useful for abdominal bloating, indigestion and colic.
- Ginger also supresses inflammation.
Exercise improves circulation and rids the body of toxins.
- Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
- Weight training builds muscle. Read more about Exercise and Fitness.
- Stretching improves flexibilty. Read more about Exercise and Fitness.
Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal.
What Do Medical Research Studies Tell About Low Stomach Acid In Celiac Disease and/or Gluten Sensitivity?
RESEARCH STUDY SUMMARIES
“Endoscopic and histopathological findings of the upper gastrointestinal tract in patients with functional and organic dyspepsia.” This retrospective study investigating the frequency and type of the macroscopic and histopathological changes in the upper gastrointestinal (GI) endoscopy in patients with symptoms of dyspepsia verified that regardless of the severity of lesions of the upper GI endoscopy in patients with dyspepsia, it is advisable to biopsy from both the gastric and duodenal mucosa, which allows for an individualized management of these patients. Celiac disease should be considered in the diagnosis of the causes of dyspepsia. Reflux esophagitis was found in 8.5% of patients.
Included in this study were 212 patients with dyspepsia, at the age of 18-84 years, including 60 patients to 45 years of age (group I) and 152 patients older than 45 (group II) who underwent gastroscopy. Biopsy specimens were taken from the gastric and duodenum for histopathological examination (microscopic).
Reflux esophagitis was found in 18 patients (8.5%), slightly more common in people over 45 years of age (group I–5%, group II–9.2%). The mild forms of esophagitis occurred most frequently. A more advanced form of inflammation and Barrett’s esophagus was found only in patients over 45 years of age. Normal gastric and duodenal mucosa was revealed in 30% of patients in group I and 9.2% in group II. The most common endoscopic disorder was gastritis, mostly erythematous-exudative and less often atrophic.
The majority of patients had normal duodenal mucosa. In 3.3% of patients (group I–8.3%, group II–1.3%), who had not previously been diagnosed celiac disease, histopathological changes typical of celiac disease has been shown. In all patients, in whom biopsy specimens were taken from normal duodenal mucosa (14% of patients), histopathological examination revealed the presence of non-specific inflammation, regardless of the coexistence of H. pylori infection.8
“Gastroesophageal reflux symptoms in patients with celiac disease and the effects of a gluten-free diet.” This study investigating the prevalence of GERD symptoms at diagnosis and the impact of the gluten-free diet found that GERD symptoms are common in classically symptomatic untreated celiac disease patients and that the gluten free diet is associated with a rapid and persistent improvement in reflux symptoms that resembles the healthy population.
Subjects consisted of 133 adult celiac disease patients evaluated at diagnosis and 70 healthy controls. Fifty-three patients completed questionnaires every 3 months during the first year and more than 4 years after diagnosis. GERD symptoms were evaluated using a subdimension of the Gastrointestinal Symptoms Rating Scale for heartburn and regurgitation domains. At diagnosis, celiac patients had a significantly higher reflux symptom mean score than healthy controls. At baseline, 30.1% of celiac disease patients had moderate to severe GERD (score more than 3) compared with 5.7% of controls. Moderate to severe symptoms were significantly associated with the classical clinical presentation of celiac disease (35.0%) compared with atypical/silent cases (15.2%). A rapid improvement was evidenced at 3 months after initial treatment with a gluten free diet with reflux scores comparable to healthy controls from this time point onward.13
“Reflux esophagitis in adult coeliac disease: beneficial effect of a gluten free diet.” This study evaluating whether untreated celiac patients had an increased prevalence of reflux esophagitis and, if so, to assess whether a gluten free diet exerted any beneficial effect on GERD symptoms demonstrated celiac patients have a high prevalence of reflux esophagitis. That a gluten free diet significantly decreased the relapse rate of GERD symptoms suggests that celiac disease may represent a risk factor for the development of reflux esophagitis.14
- http://chemistry.elmhurst.edu/vchembook/184ph.html [↩]
- Tutuian, R and Castell D O. Gastroesophageal reflux monitoring: pH and impedance. GI Motility online (2006) doi:10.1038/gimo31. [↩]
- Chen X, Oshima T, Tomita T, Fukui H, Watari J, Matsumoto T, Miwa H. Acidic bile salts modulate the squamous epithelial barrier function by modulating tight junction proteins. Am J Physiol Gastrointest Liver Physiol. 2011 Aug;301(2):G203-9. doi: 10.1152/ajpgi.00096.2011. Epub 2011 May 26. [↩] [↩]
- Chen X, Oshima T, Tomita T, Fukui H, Watari J, Matsumoto T, Miwa H. Acidic bile salts modulate the squamous epithelial barrier function by modulating tight junction proteins. Am J Physiol Gastrointest Liver Physiol. 2011 Aug;301(2):G203-9. doi: 10.1152/ajpgi.00096.2011. Epub 2011 May 26. [↩]
- Cuomo A, Romano M, Rocco A, Budillon G, Del Vecchio Blanco C, Nardone G. Reflux oesophagitis in adult coeliac disease: beneficial effect of a gluten free diet. Gut. Apr 2003;52(4):514-7. [↩]
- Saad R, Bellec V, Dugay J, Blanchi A,Nachman F, Vázquez H, González A, Andrenacci P, Compagni L, Reyes H, Sugai E, Moreno ML, Smecuol E, Hwang HJ, Sánchez IP, Mauriño E, Bai JC. Gastroesophageal reflux symptoms in patients with celiac disease and the effects of a gluten-free diet. Clin Gastroenterol Hepatol. 2011 Mar;9(3):214-9. doi: 10.1016/j.cgh.2010.06.017. [↩] [↩]
- Cuomo A, Romano M, Rocco A, Budillon G, Del Vecchio Blanco C, Nardone G. Reflux oesophagitis in adult coeliac disease: beneficial effect of a gluten free diet. Gut. Apr 2003;52(4):514-7. [↩] [↩]
- Piatek-Guziewicz A, Przybylska-Feluś M, Dynowski W, Zwolińska-Wcisło M, Lickiewicz J, Mach T. Endoscopic and histopathological findings of the upper gastrointestinal tract in patients with functional and organic dyspepsia. Przegl Lek. 2014;71(4):204-9. [↩] [↩]
- Nachman F, Vázquez H, González A, Andrenacci P, Compagni L, Reyes H, Sugai E, Moreno ML, Smecuol E, Hwang HJ, Sánchez IP, Mauriño E, Bai JC. Gastroesophageal reflux symptoms in patients with celiac disease and the effects of a gluten-free diet. Clin Gastroenterol Hepatol. 2011 Mar;9(3):214-9. doi: 10.1016/j.cgh.2010.06.017. [↩]
- Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
- Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
- The Herbal Drugstore. Linda White, M.D and Steven Foster. 2000. Rodale Inc. USA. [↩]
- Saad R, Bellec V, Dugay J, Blanchi A,Nachman F, Vázquez H, González A, Andrenacci P, Compagni L, Reyes H, Sugai E, Moreno ML, Smecuol E, Hwang HJ, Sánchez IP, Mauriño E, Bai JC. Gastroesophageal reflux symptoms in patients with celiac disease and the effects of a gluten-free diet. Clin Gastroenterol Hepatol. 2011 Mar;9(3):214-9. doi: 10.1016/j.cgh.2010.06.017.. [↩]
- Cuomo A, Romano M, Rocco A, Budillon G, Del Vecchio Blanco C, Nardone G. Reflux oesophagitis in adult coeliac disease: beneficial effect of a gluten free diet. Gut. Apr 2003;52(4):514-7. [↩]
