Great Smokies Medical Center of Asheville

Archive for March, 2011

Osteopathic Manual Therapy

Friday, March 4th, 2011


Osteopathy is a holistic medical treatment modality developed by Andrew Taylor Still, M.D. in the Midwestern United States at the end of the 19th Century. Osteopathy emphasizes the role of the framework of the musculoskeletal system in health and disease, including the connective tissue that supports all organs and tissues.

Dr. Still promoted the concepts that body structure and body function are intimately related and that the body is an integrated unit of mind, body, and spirit.

Balanced alignment of the body assists the inherent self-regulatory and self-healing mechanisms of the body by allowing the blood to nourish the tissues and waste products to be removed, in addition to promoting optimal nervous system function and assisting free and efficient movement.

Structural imbalances are too often undiagnosed even though they are common causes of pain, restricted movement, feeling unwell, and eventually even disease. Physicians familiar with the relationship between body structure and function are often able to go beyond treating symptoms and managing disease by treating the root causes of health problems.

Osteopathic Manual Therapy

By using treatments that focus on the inherent health and self-correcting mechanisms to guide treatment, Dr. Hoch finds his patients are often able to obtain lasting results without ongoing visits. Dr. Hoch uses a variety of gentle techniques to help the body align itself, including:

  • Myofascial release to correct tension, laxity, or displacement of fascia, the web of connective tissue surrounding and connecting organs and the musculoskeletal system 
  • Cranial osteopathy to support normal cerebrospinal fluid flow and nervous system health and optimal functioning of the head and neck
  • Visceral osteopathy to assist health and function of the internal organs

Dr. Hoch counsels patients re: posture, diet, exercise, etc., to help them maximize their health and treatment benefits. His goal in using osteopathic treatment is simple: to help patients be able to do activities comfortably.

Cranial Osteopathy

Cranial Osteopathy is based on perceiving and working with the inherent mobility in the brain, spinal cord, skull, and surrounding tissues, all of which are subjected to subtle cranial pulsations or rhythms.
Imbalances in cerebrospinal fluid flow, tension in the nervous system, and misalignments in the skull, face, and spine can be relieved and balance restored through gentle manipulation of the skull.

The subtle cranial rhythms in cranial osteopathy were discovered by Dr. Still’s student William Garner Sutherland, D.O. more than 100 years ago. The presence of these rhythms has since been validated by several scientific methodologies. The cranial osteopathic method is now used around the world. 

Conditions Treated

Back pain
   ~ motor vehicle, falls, sports injuries,  sprains, healing after fractures
Neck pain
Pain syndromes
Plantar fasciitis/Heel spurs
Rib pain 
Temperomandibular joint (TMJ) syndrome
Tension headaches

The following conditions are treated when a structural component is found on exam:

Asthma/Breathing problems
Facial pain
Gallbladder problems
Menstrual cramps
Migraine headaches 
Recurrent ear infections in children

Heidelberg Gastric Analysis

Friday, March 4th, 2011

Digestion Overview

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.

November 2010 Health Matters

Wednesday, March 2nd, 2011

November 2010 (Download PDF)

Introducing Mark Hoch, M.D.

We are pleased to announce that Dr. Mark Hoch will join GSMC as a staff physician and will accept new patients starting December 1, 2010.

Three Cases of Applied Mindbody Medicine

Learn how mindbody therapies can be used to improve clinical outcomes of common ailments.

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