Great Smokies Medical Center of Asheville

Archive for the ‘Digestive Disturbances’ Category

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.

Enzymes: Life’s Labor Force

Monday, August 22nd, 2005

Health Matters July/August 2005 (PDF)

Acid Reigns

Monday, August 22nd, 2005

Health Matters July/August 2005 (PDF)

Lactose Intolerance

Monday, August 22nd, 2005

Lactose intolerance is the inability to digest significant amounts of lactose, the predominant sugar of milk. This inability results from a shortage of the enzyme lactase, which is normally produced by the cells that line the small intestine. Lactase breaks down milk sugar into simpler forms that can then be absorbed into the bloodstream. When there is not enough lactase to digest the amount of lactose consumed, the results, although not usually dangerous, may be very distressing. While not all persons deficient in lactase have symptoms, those who do are considered to be lactose intolerant.

Common symptoms include nausea, cramps, bloating, gas, and diarrhea, which begin about 30 minutes to 2 hours after eating or drinking foods containing lactose. The severity of symptoms varies depending on the amount of lactose each individual can tolerate.

Some causes of lactose intolerance are well known. For instance, certain digestive diseases and injuries to the small intestine can reduce the amount of enzymes produced. In rare cases, children are born without the ability to produce lactase. For most people, though, lactase deficiency is a condition that develops naturally over time. After about the age of 2 years, the body begins to produce less lactase. However, many people may not experience symptoms until they are much older.

Between 30 and 50 million Americans are lactose intolerant. Certain ethnic and racial populations are more widely affected than others. As many as 75 percent of all African-Americans and Native Americans and 90 percent of Asian Americans are lactose intolerant. The condition is least common among persons of northern European descent.

Although testing is available that can diagnose lactose intolerance, they require drinking a lactose-loaded beverage, which can cause acute distress to the person drinking it, and can be expensive. Thankfully, once the suspicion of lactose intolerance is raised, simply stopping eating and drinking lactose containing foods and beverages is the treatment of choice. If symptoms go away, then lactose intolerance is very likely the appropriate diagnosis.

Fortunately, lactose intolerance is relatively easy to treat. No treatment exists to improve the body’s ability to produce lactase, but symptoms can be controlled through diet. Young children with lactase deficiency should not eat any foods containing lactose. Most older children and adults need not avoid lactose completely, but individuals differ in the amounts of lactose they can handle. For example, one person may suffer symptoms after drinking a small glass of milk, while another can drink one glass but not two. Others may be able to manage ice cream and aged cheeses, such as cheddar and Swiss but not other dairy products. Dietary control of lactose intolerance depends on each person’s learning through trial and error how much lactose he or she can handle.

For those who react to very small amounts of lactose or have trouble limiting their intake of foods that contain lactose, lactase enzymes are available without a prescription. One form is a liquid for use with milk. A few drops are added to a quart of milk, and after 24 hours in the refrigerator, the lactose content is reduced by 70 percent. The process works faster if the milk is heated first, and adding a double amount of lactase liquid produces milk that is 90 percent lactose free. A more recent development is a chewable lactase enzyme tablet that helps people digest solid foods that contain lactose. Three to six tablets are taken just before a meal or snack.

Lactose-reduced milk and other products are available at many supermarkets. The milk contains all of the nutrients found in regular milk and remains fresh for about the same length of time or longer if it is super-pasteurized. There are several foods that contain much more calcium and much more bio-available calcium per serving than dairy products. Click here for a list of non-dairy sources of dietary calcium.

Although milk and foods made from milk are the only natural sources, lactose is often added to prepared foods. People with very low tolerance for lactose should know about the many food products that may contain lactose, even in small amounts. Food products that may contain lactose include:

* Bread and other baked goods
* Processed breakfast cereals.
* Instant potatoes, soups, and breakfast drinks.
* Margarine
* Lunch meats (other than kosher)
* Salad dressings.
* Candies and other snacks
* Mixes for pancakes, biscuits, and cookies

Some products labeled nondairy, such as powdered coffee creamer and whipped toppings, may also include ingredients that are derived from milk and therefore contain lactose.

Smart shoppers learn to read food labels with care, looking not only for milk and lactose among the contents but also for such words as whey, curds, milk by-products, dry milk solids, casein, sodium caseinate, and nonfat dry milk powder. If any of these are listed on a label, the item contains lactose. Click here for a list of sources of dairy products.

In addition, those with severe lactose intolerance need to know that lactose is used as the base for more than 20 percent of prescription drugs and about 6 percent of over-the-counter medicines. Many types of birth control pills, for example, contain lactose, as do some tablets for stomach acid and gas. A single dose of medication in a lactose base may be tolerated, but add the cumulative effect of multiple daily doses of several prescription drugs that contain lactose, and the effect may be noticeable to a lactose sensitive individual. Lactose intolerance is almost always dose related.

There are other health issues besides lactose intolerance surrounding the use of dairy products, including allergy, the use of bovine growth hormone and its known and unknown impact on human health, and toxic substances in milk including pesticides and herbicides. Cow’s milk is the perfect food-for calves. We recommend the preferred treatment of a known intolerance of any food, including lactose intolerance, is avoidance. Since digestion is a complex process that is critical for good health, a careful approach to avoidance of lactose is the key to reducing symptoms and protecting future health for a lactose sensitive individual.

Irritable Bowel Syndrome (IBS)

Monday, August 22nd, 2005

Irritable bowel syndrome (IBS) is a common disorder of the intestines that leads to crampy pain, gassiness, bloating, and changes in bowel habits. Some people with IBS have constipation (difficult or infrequent bowel movements); others have diarrhea (frequent loose stools, often with an urgent need to move the bowels); and some people experience both. Sometimes the person with IBS has a crampy urge to move the bowels but cannot do so.

Through the years, IBS has been called by many names–colitis, mucous colitis, spastic colon, spastic bowel, and functional bowel disease. Most of these terms are inaccurate. Colitis, for instance, means inflammation of the large intestine (colon). IBS, however, does not cause inflammation and should not be confused with another disorder, ulcerative colitis.

The cause of IBS is not known, and as yet there is no cure. Doctors call it a functional disorder because there is no sign of disease when the colon is examined. IBS causes a great deal of discomfort and distress, but it does not cause permanent harm to the intestines and does not lead to intestinal bleeding of the bowel or to a serious disease such as cancer. Often IBS is just a mild annoyance, but for some people it can be disabling. They may be unable to go to social events, to go out to a job, or to travel even short distances.

The colon, which is about 6 feet long, connects the small intestine with the rectum and anus. The major function of the colon is to absorb water and mineral salts from digestive products that enter from the small intestine. Two quarts of liquid matter enter the colon from the small intestine each day. This material may remain there for several days until most of the fluid and salts are absorbed into the body. The stool then passes through the colon by a pattern of movements to the left side of the colon, where it is stored until a bowel movement occurs.

Colon motility (contraction of intestinal muscles and movement of its contents) is controlled by nerves and hormones and by electrical activity in the colon muscle. The electrical activity serves as a “pacemaker” similar to the mechanism that controls heart function. Movements of the colon propel the contents slowly back and forth but mainly toward the rectum. A few times each day strong muscle contractions move down the colon pushing fecal material ahead of them. Some of these strong contractions result in a bowel movement.

Because doctors have been unable to find an organic cause, IBS often has been thought to be caused by emotional conflict or stress. While stress may worsen many symptoms including IBS symptoms, research suggests that other factors also are important. Researchers have found that the colon muscle of a person with IBS begins to spasm after only mild stimulation. The person with IBS seems to have a colon that is more sensitive and reactive than usual, so it responds strongly to stimuli that would not bother most people.

Ordinary events such as eating and distention from gas or other material in the colon can cause the colon to overreact in the person with IBS. Certain medicines and foods may trigger spasms in some people. Sometimes the spasm delays the passage of stool, leading to constipation. Chocolate, milk products, or large amounts of alcohol are frequent offenders. Caffeine (in coffee, in particular) causes loose stools in many people, but it is more likely to affect those with IBS. Researchers also have found that women with IBS may have more symptoms during their menstrual periods, suggesting that reproductive hormones can increase IBS symptoms.

If you are concerned about IBS, it is important to realize that normal bowel function varies from person to person. Normal bowel movements range from as many as three stools a day to as few as three a week. A normal movement is one that is formed but not hard, contains no blood, and is passed without cramps or pain. Though three stools a week may be “normal” for some individuals, it is not optimal over a lifetime, as the bowel lining has much increased time for exposure to toxins that are part and parcel of an increasingly contaminated food source. This increased exposure to toxins as a result of less frequent stools can result in increased cancer risk.

People with IBS, on the other hand, usually have crampy abdominal pain with painful constipation or diarrhea. In some people, constipation and diarrhea alternate. Sometimes people with IBS pass mucus with their bowel movements. Bleeding, fever, weight loss, and persistent severe pain are not symptoms of IBS but may indicate other problems.

IBS usually is diagnosed after doctors exclude the presence of disease. To get to that point, the doctor will take a complete medical history that includes a careful description of symptoms. A physical examination and laboratory tests will be done. A stool sample will be tested for evidence of bleeding. The doctor also may do diagnostic procedures such as x-rays or endoscopy (viewing the colon through a flexible tube inserted through the anus) to find out if there is disease. At Great Smokies Medical Center, we rule out several possible causes that could cause symptoms similar to IBS such as chronic bacterial or yeast infections and parasitic infestations through a Comprehensive Digestive Stool Analysis. We also rule out intolerance of food from any cause, including but not limited to food allergy, gluten intolerance, and lactose intolerance. In addition, knowing that IBS can be the result of a disturbance in the autonomic nervous system, we would assess any problem with the sympathetic nervous system (which readies a body for “fight or flight”) through Heart Rate Variability monitoring. We would also do a nutritional assessment, of minerals in particular, to see if the downstream effects of IBS have nutritionally compromised the affected person.

The potential for abnormal function of the colon is always present in people with IBS, but a trigger also must be present to cause symptoms. The most likely culprits seem to be diet and emotional stress. Many people report that their symptoms occur following a meal or when they are under stress. No one is sure why this happens, but scientists have some clues.

Eating causes contractions of the colon. Normally, this response may cause an urge to have a bowel movement within 30 to 60 minutes after a meal. In people with IBS, the urge may come sooner with cramps and diarrhea. For some, the strength of the response can be related to the number of calories in a meal and especially the amount of fat in a meal. Fat in any form (animal or vegetable) can be a strong stimulus of colonic contractions after a meal. Many foods contain fat, especially meats of all kinds, poultry skin, whole milk, cream, cheese, butter, vegetable oil, margarine, shortening, avocados, and whipped toppings. Grains are among the common culprits in those with food allergy accounting for bowel symptoms. Large meals can cause cramping and diarrhea in people with IBS. Symptoms may be eased if you eat smaller meals more often or just eat smaller portions.

Stress may also stimulate colonic spasm in people with IBS. This process is not completely understood, but scientists point out that the colon is controlled partly by the autonomic nervous system. Stress reduction (relaxation) training or counseling and support help relieve IBS symptoms in some people. However, this does not mean IBS is the result of a personality disorder. IBS is at least partly a disorder of colon motility. Whether or not stress is a direct cause of IBS or not, the symptoms of severe IBS can themselves often cause stress in the life of the affected individual.

For many people, eating a proper diet lessens IBS symptoms. Before changing your diet, it is a good idea to keep a journal noting which foods seem to cause distress. Discuss your findings with your doctor. For instance, if dairy products cause your symptoms to flare up, you can try eating less of those foods.

Dietary fiber may lessen IBS symptoms in many cases. Beans, fruits, and vegetables are good sources of fiber. Consult your doctor before using an over-the-counter fiber supplement. High-fiber diets give the stool more bulk, which may help to prevent spasms from developing. Some forms of fiber also keep water in the stools, thereby preventing hard stools that are difficult to pass. Click here for more information on types of fiber. Doctors usually recommend that you eat just enough fiber so that you have soft, easily passed, and painless bowel movements. High-fiber diets, particularly cellulose fiber, may initially cause gas and bloating, but within a few weeks, these symptoms often go away as your body adjusts to the fiber. Pectin, a water soluble fiber, is generally better tolerated

Your doctor may prescribe fiber supplements or occasional laxatives if you are constipated. Some doctors prescribe drugs that control colon muscle spasms, drugs that slow the movement of food through the digestive system, tranquilizers, or antidepressant drugs. At GSMC we prefer to first identify any cause of symptoms and remove that cause if possible. It is important to follow the physician’s instructions when taking IBS medications–particularly laxatives, which can be habit forming if not used carefully.

IBS has not been shown to lead to any serious, organic diseases. No link has been established between IBS and inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis. IBS does not lead to cancer. Some patients have a more severe form of IBS, and the pain and diarrhea may cause them to withdraw from normal activities. These patients need to work with their physicians to find the best combination of avoidance of contributing causes, medicine, diet, counseling, and support to control their symptoms.

Causes and Treatments of GERD

Monday, August 22nd, 2005

An estimated 60 million Americans suffer from Gastro-Esophogeal Reflux Disease (GERD), 15 million of them with daily episodes. GERD is a condition where digestive fluids from the stomach backwash into the esophagus, the tube that carries food/liquid from the mouth to the stomach and throat. Symptoms may include heartburn, an acidic taste in the back of the mouth, burning under the breastbone, and chest pain that can be confused with the pain of a heart attack. At times patients may have no symptoms other than chronic hoarseness, sore throat, gingivitis, or bad breath.

Conditions that predispose one to GERD include being overweight (which increases the amount of intra-abdominal fat and pressure), presence of a hiatal hernia, wearing tight clothing, overeating, eating rich foods, and drinking alcohol and coffee.

A healthy stomach naturally produces concentrated hydrochloric acid to digest food. pH is a measurement of acidity on a scale from 0-14. The normal pH of the stomach is very acid at 1-2, and the normal pH of the esophagus is slightly alkaline at 7-8. The mucous membranes of the stomach protect the stomach from being digested by hydrochloric acid. The esophagus, however, is not protected from these hydrochloric acid so it can become irritated or damaged by this exposure, resulting in the symptoms of GERD.

Conventional therapies for GERD include treatment with special types of antihistamines, especially Zantac, Tagamet, and Axid, as well as other medications called Proton Pump Inhibitors (PPIs) like Propulsid and Nexia. These drugs decrease stomach acid production. The long-term blocking of stomach acid production, however, is a valid health concern as acid is required for the breakdown of protein, a nutrient needed as a building block of body tissues, and also is required for absorption of minerals essential for health. By prescribing such drug treatments, an assumption is made that GERD symptoms are caused by excess acid production in the stomach, often without testing for the presence of excessive acidity.

GERD is a response to an acid/alkaline imbalance in the stomach, from either excess or deficient stomach acid. The fact that GERD is often caused by inadequate stomach acid production is usually overlooked. Too little stomach acid can trigger the backwash response, especially in older individuals. Studies suggest that 60% of individuals over age 60 make too little hydrochloric acid, with the percentage increasing with advancing age.

Natural therapies for this condition can include a surprisingly effective simple technique of food combining-avoiding starches and sugars (bread, potatoes, pasta, fruit, desserts, etc.) and protein (meat, eggs, fish, etc.) at the same meal. Supplementing hydrochloric acid (HCl) by capsule, always dosed to the size of a meal, has resulted in complete relief of GERD for some patients. Herbal treatments are useful, including a special form of licorice called deglycyrrhizinated licorice, often combined with other herbs such as plantain, slippery elm, and marshmallow root.

Red blood cell or hair analysis often reveals an overall decrease in essential minerals, since stomach acid is critical for the absorption of minerals. Mineral supplementation taken with acidic lemon water can help remedy this deficiency. Delivering specific electrical stimulation to a group of autonomic nerves called the celiac plexus in the upper abdomen that control the functions of the stomach and esophagus can be helpful in reducing the symptoms of GERD.

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